The effectiveness of physical therapist-administered group-based exercise on fall prevention: a systematic review of randomized controlled trials.

BACKGROUND

Falls are a verified cause of morbidity and mortality in adults older than 65 years. Exercise under the direction of a physical therapist has been shown to reduce the risk of falls in older adults; however, it is not clear whether physical therapist-directed group-based exercise could produce similar results.

PURPOSE

The purpose of this systematic review was to summarize the evidence on the effectiveness of physical therapist-administered group-based exercise when compared with various controls for falls prevention and improvement of quality of life.

METHODS

A computerized search of PubMed and CINAHL was performed. An exhaustive hand search was also performed of the references of all full-text articles. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed for this review. Studies were included if they met the following criteria: (1) comparison of group-based exercise led by a physical therapist to a control group; (2) ambulatory elderly men or women, aged 65 years or older; (3) subjects in the community or institutional setting; (4) the use of 1 or more outcome measures related to functional balance and/or quality of life; (5) randomized controlled or clinical trials; and (6) published in English, between December 1, 2001, and June 7, 2012. The PEDro scale was used to assess the quality of each study included in this review.

RESULTS

The computerized search strategy and hand search revealed 213 potential articles, 10 of which met the inclusion criteria. After assessment with the PEDro scale, 8 of these were considered high-quality studies (score > 6/10). Seven studies compared group-based exercise to a nonexercise control group, while 3 studies compared group-based exercise with a physical therapist-prescribed home exercise program. Outcomes measured include fall rate, balance, physical performance, health-related quality of life, and fear of falling.

DISCUSSION

When group-based exercise was compared with no intervention, group-based exercise was found to be more effective in decreasing fall frequency, increase balance, and improve quality of life. When compared with a physical therapist-prescribed home exercise program, the group-based exercise results were not statistically different but showed improvements in some quality of life and physical functioning measures. There is also some evidence to suggest that group-based exercise promotes greater patient satisfaction and exercise adherence.

CONCLUSION

There is preliminary evidence to suggest that the group-based exercise is effective for falls prevention, quality-of-life enhancement, and balance improvements in the older adults comparable with traditional home exercise programs.