Systematic review Featured article| Volume 102, ISSUE 1, P132-154, January 2021

Effectiveness of Physical Therapy Interventions in Reducing Fear of Falling Among Individuals With Neurologic Diseases: A Systematic Review and Meta-analysis



      To summarize the effectiveness of physical therapy interventions to reduce fear of falling (FOF) among individuals living with neurologic diseases.

      Data Sources

      PubMed, Physiotherapy Evidence Database, Scopus, Web of Science, PsycINFO, Cumulative Index to Nursing and Allied Health, and SportDiscuss were searched from inception until December 2019.

      Study Selection

      Clinical trials with either the primary or secondary aim to reduce FOF among adults with neurologic diseases were selected.

      Data Extraction

      Potential articles were screened for eligibility, and data were extracted by 2 independent researchers. Risk of bias was assessed by the Cochrane Risk of Bias tool for randomized controlled trials and the National Institutes of Health Quality Assessment Tool for pre-post studies. A meta-analysis was performed among trials presenting with similar clinical characteristics. The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) was used to rate the overall quality of evidence.


      Sixty-one trials with 3954 participants were included in the review and 53 trials with 3524 participants in the meta-analysis. The included studies presented, in general, with a low to high risk of bias. A combination of gait and balance training was significantly more effective compared with gait training alone in reducing FOF among individuals with Parkinson disease (PD) (mean difference [MD]=11.80; 95% CI, 8.22-15.38; P<.001). Home-based exercise and leisure exercise demonstrated significant improvement in reducing FOF over usual care in multiple sclerosis (MS) (MD=15.27; 95% CI, 6.15-24.38; P=.001). No statistically significant between-groups differences were reported among individuals with stroke and spinal cord injury. The overall quality of evidence presented in this review ranges from very low to moderate according to the assessment with the GRADE approach.


      Gait with lower limb training combined with balance training is effective in reducing FOF in individuals with PD. Also, home-based or leisure exercise is effective among individuals with MS. However, because of several limitations of the included studies, further research is needed to examine the effectiveness of FOF intervention among individuals with neurologic diseases.


      List of abbreviations:

      ABC (Activities-specific Balance Confidence), CP (cerebral palsy), FES-I (Fall Efficacy Scale-International), FOF (fear of falling), GRADE (Grading of Recommendations, Assessment, Development, and Evaluation), MCID (minimal clinically important difference), MD (mean difference), MS (multiple sclerosis), PD (Parkinson disease), PT (physical therapy), RCT (randomized controlled trial), SCI-FCS (Spinal Cord Injury-Falls Concern Scale), SCI (spinal cord injury), SMD (standardized mean difference), TBI (traumatic brain injury)
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