Surface perturbation training to prevent falls in older adults: A highly pragmatic, randomized controlled trial

Background. Falls are the leading cause of injuries among older adults, and trips and slips are major contributors to falls. Objective. The authors sought to compare the effectiveness of adding a component of surface perturbation training to usual gait/balance training for reducing falls and fallrelated injury in high-risk older adults referred to physical therapy. Design. This was a multi-center, pragmatic, randomized, comparative effectiveness trial. Setting. Treatment took place within 8 outpatient physical therapy clinics. Patients. This study included 506 patients 65+ years of age at high fall risk referred for gait/balance training. Intervention. This trial evaluated surface perturbation treadmill training integrated into usual multimodal exercise-based balance training at the therapist's discretion versus usual multimodal exercise-based balance training alone. Measurements. Falls and injurious falls were assessed with a prospective daily fall diary, which was reviewed via telephone interview every 3 months for 1 year. A total of 211/253 (83%) patients randomized to perturbation training and 210/253 (83%) randomized to usual treatment provided data at 3-month follow-up. At 3 months, the perturbation training group had a significantly reduced chance of fall-related injury (5.7% versus 13.3%; relative risk 0.43) but no significant reduction in the risk of any fall (28% versus 37%, relative risk 0.78) compared with usual treatment. Time to first injurious fall showed reduced hazard in the first 3 months but no significant reduction when viewed over the entire first year. Limitations. The limitations of this trial included lack of blinding and variable application of interventions across patients based on pragmatic study design. Conclusion. The addition of some surface perturbation training to usual physical therapy significantly reduced injurious falls up to 3 months posttreatment. Further study is warranted to determine the optimal frequency, dose, progression, and duration of surface perturbation aimed at training postural responses for this population.