Effects of Perturbation-Based Treadmill Training on Balance Performance, Daily Life Gait, and Falls in Older Adults: REACT Randomized Controlled Trial.

The primary outcome, daily-life gait quality, was null, so the positive findings for physical performance, fear of falling, and falls are secondary. Falls were not the primary outcome, and the authors stated the study was expected to be underpowered for falls. The paper reports 70 participants and 35 per group, but also reports dropouts and exclusions from wearable analyses, so the final number analyzed is not stated clearly. Training difficulty was adjusted by therapist judgment without an objective performance measure, so the challenge received may vary. Only assessors were blinded; therapists assigned and adjusted the training, so they knew group allocation. Baseline falls were reported by recall over 6 months, and follow-up used fall calendars without monthly phone calls. The 6-month fall follow-up overlapped a COVID-19 lockdown in the Netherlands, which affected 9 REACT and 10 control participants. Participants were generally healthy, cognitively intact, and excluded for neurological, cardiovascular, pulmonary, or recent orthopedic problems, so results may not apply to people with cognitive impairment or those conditions. The daily-life gait quality composite score may not be sensitive enough to detect change, according to the authors.

Funding came from the European Union’s Horizon 2020 program, Vidi, and the Dutch Organization for Scientific Research. The authors stated the funder played no role in design, conduct, or reporting. No other conflict-of-interest statement appears in the supplied text.

Do not conclude that perturbation training improves daily-life walking quality or has been proven to reduce falls. The primary daily-life gait quality outcome was null, and the fall reduction was a secondary outcome the authors expected the study to be underpowered for.