Disentangling interventions to reduce fear of falling in community-dwelling older people: a systematic review and meta-analysis of intervention components

Figures & data

Figure 1. Flowchart of study selection process. Adapted from Moher et al. [21].

Figure 2. Forest plot of the 52 intervention arms included in the overall meta-analysis.

Table 1. Meta-regression results for intervention components for the first available follow-up after the intervention.

	Component^a	Studies with component	n yes/n no (intervention)^b	n yes/n no (control)	Regression coefficient (change in SMD)	SE	p Value	CI low	CI high	Heterogeneity (I^2, %)
1	Assertiveness training	8, 66	421/2367	431/2242	0.18	0.41	0.657	–0.64	1.01	78.5
2	Assistive devices	10, 29, 46, 50	229/2391	233/2311	0.49	0.31	0.130	–0.15	1.12	77.9
3	Balance	1, 3a, 4, 6, 10, 11a, 12, 13a, 14, 15, 16, 21a, 29, 31, 42, 45, 47, 50, 55, 59a, 64a, 65a	1573/1215	1492/1181	0.45*	0.17	0.010^b,e,f	0.11	0.78	75.2
4	Behavioral activation	31, 37	301/2487	317/2356	0.17	0.41	0.690	–0.66	1.00	78.6
5	Body awareness	11a, 15, 33, 34, 36a, 47, 53, 55, 58, 63, 64a	479/2309	446/2227	–0.53*	0.20	0.010^e,g	–0.93	–0.13	75.9
6	Booster	6	17/2046	12/1963	–0.13	0.69	0.847	–1.52	1.25	78.5
7	Cognitive processing	10, 34, 44, 47, 58, 59a, 60a, 60b, 64a	374/2414	317/2356	–0.03	0.23	0.881	–0.50	0.43	77.9
8	Cognitive restructuring	8, 10, 14, 31, 37, 47, 66	1062/1726	1038/1635	0.25	0.24	0.299	–0.23	0.73	78.5
9	Cool-down	11a, 13a, 16, 20, 27, 28, 30a, 34, 47, 62, 63, 64a	653/2135	636/2037	–0.19	0.21	0.369	–0.61	0.23	78.4
10	Daily task	1, 4, 10, 16, 21a, 31, 49, 55, 59a, 60a, 60b	478/2142	438/2106	0.32	0.21	0.141	–0.11	0.74	78.6
11	Demonstration of behavior	8, 10, 21a, 36a, 63	232/2388	254/2290	0.14	0.30	0.642	–0.46	0.75	78.8
12	Diet	29	49/2739	43/2630	0.39	0.60	0.523	–0.82	1.60	78.5
13	Discouraged	10	18/2770	15/2658	0.87	0.66	0.197	–0.46	2.20	78.2
14	Discussion	8, 10, 11a, 17, 29, 38a, 47, 65a, 66	985/1803	882/1791	0.38	0.22	0.086	–0.06	0.81	78.3
14.1	Discussion – informal caregiver	10	18/2770	15/2658	0.87	0.66	0.197	–0.46	2.20	78.2
14.2	Discussion – peer	10, 11a, 17, 47, 66	534/2254	476/2197	0.38	0.28	0.184	–0.19	0.96	78.5
14.3	Discussion – supervisor	8, 10, 11a, 17, 29, 38a, 47, 65a, 66	985/1803	882/1791	0.38	0.22	0.086	–0.06	0.81	78.3
14.4	Discussion – other	–	0/2788	0/2673	–	–	–	–	–	–
15	Education – environmental fall risk factors	4, 8, 10, 29, 47, 50, 65a, 66	1038/1733	956/1696	0.43	0.22	0.056^d	–0.01	0.88	78.0
16	Education – physical fall risk factors	4, 8, 10, 29, 50, 60a, 60b, 65a, 66	920/1851	860/1792	0.38	0.22	0.087	–0.06	0.82	77.7
17	Education – psychological fall risk factors	4, 8, 10, 29, 47, 50, 66	864/1907	842/1810	0.42	0.24	0.084	–0.06	0.89	78.5
18	Education – other	6, 8, 10, 14, 29, 31, 46, 65a, 66	1001/1693	927/1647	0.36	0.22	0.114	–0.09	0.80	78.5
19	Endurance	1, 3a, 4, 7a, 10, 12, 13a, 21a, 42, 47, 59a, 60a, 60b, 62	815/1973	784/1889	0.35	0.19	0.073	–0.03	0.74	77.5
20	Energy conservation	14	154/2634	146/2527	0.11	0.58	0.847	–1.05	1.27	78.5
21	Exergames	19a, 24, 44, 49, 58	145/2643	147/2526	–0.04	0.30	0.892	–0.64	0.56	78.3
22	Exposure	8, 31, 37	442/2346	488/2185	0.14	0.34	0.681	–0.55	0.83	78.5
23	Fall recovery	1, 10, 14, 47	369/2402	320/2332	0.33	0.31	0.296	–0.30	0.97	79.0
24	Feedback	6, 10, 24, 44, 45, 49, 58, 60a, 60b	213/2538	186/2452	–0.11	0.24	0.641^g	–0.60	0.38	78.3
24.1	Feedback – device	24, 44, 45, 49, 58	128/2623	126/2512	–0.27	0.31	0.381^g	–0.89	0.35	78.2
24.2	Feedback – peer	10	18/2733	15/2623	0.86	0.67	0.204	–0.48	2.20	78.6
24.3	Feedback – supervisor	6, 10, 58, 60a, 60b	123/2628	102/2536	0.09	0.31	0.771	–0.53	0.71	78.9
24.4	Feedback – other	10	18/2733	15/2623	0.86	0.67	0.204	–0.48	2.20	78.6
25	Flexibility	1, 7a, 11a, 13a, 21a, 30a, 47, 64a, 66	821/1967	800/1873	0.31	0.23	0.181	–0.15	0.76	77.7
26	Generalization	14	154/2634	146/2527	0.11	0.58	0.847	–1.05	1.27	78.5
27	Goal setting	6, 8, 10, 29, 37, 38a, 46, 47, 49, 66	1004/1617	960/1545	0.19	0.22	0.402	–0.26	0.63	79.2
28	Hip protector	29	49/2739	43/2630	0.39	0.60	0.523	–0.82	1.60	78.5
29	Holistic (e.g., Tai Chi, yoga, Pilates, and Ving Tsun)	1, 20, 28, 33, 34, 35, 36a, 53, 63	245/2543	236/2437	–0.67*	0.21	0.003^b,e,g	–1.10	–0.24	74.5
30	Home adaptation	8, 14, 29, 38a, 46, 50, 66	873/1915	873/1800	0.28	0.24	0.242	–0.20	0.76	78.3
31	Home care	29	49/2739	43/2630	0.39	0.60	0.523	–0.82	1.60	78.5
32	Home screening	8, 10, 14, 29, 38a, 46, 50, 65a, 66	1065/1723	1002/1671	0.38	0.21	0.078	–0.04	0.81	77.8
33	Incontinence	29	49/2739	43/2630	0.39	0.60	0.523	–0.82	1.60	78.5
34	Increase in difficulty	1, 3a, 4, 6, 7a, 10, 11a, 13a, 15, 16, 19a, 20, 21a, 22, 27, 28, 31, 35, 36a, 37, 39a, 42, 44, 45, 47, 49, 58, 59a, 60a, 60b, 64a	1516/1272	1467/1206	0.20	0.18	0.290	–0.17	0.57	78.5
35	Integration into daily life	1, 6	46/2742	42/2631	0.16	0.47	0.740	–0.78	1.10	78.6
36	Mastery	6, 10, 15, 17, 24, 27, 31, 35, 42, 44, 47, 63	572/2169	503/2119	0.10	0.21	0.650	–0.33	0.52	77.9
37	Medicine modification	29, 31, 46, 65a	391/2397	323/2350	0.34	0.30	0.268	–0.27	0.95	77.9
38	Meditation	20, 34, 35, 36a, 53	148/2640	141/2532	–0.79*	0.28	0.007^b,e,g	–1.35	–0.23	75.0
39	Modeling	8, 10, 31	296/2492	323/2350	0.41	0.35	0.249	–0.30	1.18	78.5
40	Motivational interviewing	8, 29	190/2598	214/2459	0.23	0.42	0.585	–0.62	1.08	78.6
41	Motivational strategy	4, 8, 10, 12, 13a, 15, 17, 21a, 30a, 31, 35, 36a, 42, 44, 45, 49, 58, 59a, 65a, 66	1422/1212	1376/1151	0.23	0.18	0.222	–0.14	0.60	77.8
41.1	Motivational strategy – informal caregiver	10	18/2616	15/2512	0.87	0.67	0.199	–0.47	2.21	78.6
41.2	Motivational strategy – device	45, 49, 58	98/2536	94/2433	–0.27	0.38	0.482^g	–1.04	0.50	78.5
41.3	Motivational strategy – peer	10, 13a	239/2395	273/2254	0.64	0.43	0.149	–0.24	1.51	77.8
41.4	Motivational strategy – supervisor	4, 8, 10, 12, 13a, 17, 21a, 30a, 31, 35, 36a, 42, 44, 59a, 65a, 66	1304/1330	1268/1259	0.37	0.19	0.054^b,c,g	–0.01	0.74	76.7
41.5	Motivational strategy – other	8, 15, 44	176/2458	202/2325	–0.13	0.38	0.725	–0.90	0.63	78.8
42	Motor coordination	10, 11a, 15, 20, 44, 45, 47, 49, 59a, 63, 64a	437/2351	391/2282	–0.03	0.22	0.885	–0.47	0.41	78.0
43	Multitasking	10, 12, 16, 22, 27, 44, 47, 58, 59a, 60a, 60b	397/2391	338/2335	0.20	0.22	0.361	–0.24	0.64	78.5
44	Option for additional personal assistance	4, 10, 11a, 14, 17, 31, 42, 44, 47, 50	877/1911	837/1836	0.41	0.21	0.055^b,d	–0.01	0.82	78.0
45	Peer interaction	1, 10, 11a, 13a, 16, 17, 47, 66	818/1970	785/1888	0.33	0.23	0.161	–0.14	0.80	77.9
46	Perceptual training^i	47	168/2620	129/2544	0.01	0.58	0.990	–1.15	1.17	78.4
47	Persuasion	–	0/2634	0/2527	–	–	–	–	–	–
48	Podiatry	29, 50	180/2608	189/2484	0.46	0.42	0.278	–0.38	1.29	77.7
49	Problem solving	8, 10, 14, 29, 37, 38a, 65a, 66	1067/1721	1007/1666	0.32	0.22	0.164	–0.13	0.77	78.5
50	Referral	29, 31, 38a, 65a	447/2264	372/2223	0.38	0.30	0.218	–0.23	0.98	77.9
51	Reflection	10, 37, 66	462/2326	455/2218	0.34	0.35	0.345	–0.37	1.04	78.6
52	Reinforcement^i	6, 12, 14, 21a, 31	350/2438	343/2330	0.27	0.29	0.355	–0.31	0.85	78.4
53	Relaxation	17, 35, 36a, 53	91/2697	85/2588	–0.10	0.35	0.781	–0.79	0.60	78.5
54	Reminder	1, 6, 10, 13a, 31	422/2366	452/2221	0.43	0.28	0.138	–0.14	1.00	77.1
55	Repetition	1, 3a, 4, 6, 7a, 8, 10, 11a, 12, 13a, 14, 15, 16, 17, 19a, 20, 21a, 22, 24, 27, 28, 29, 30a, 31, 33, 34, 35, 36a, 37, 38a, 39a, 42, 44, 45, 46, 47, 49, 50, 53, 55, 58, 59a, 60a, 60b, 62, 63, 64a, 66	2614/174	2559/114	–0.39	0.57	0.501	–1.54	0.77	78.2
56	Safety	4, 6, 10, 11a, 14, 15, 19a, 44, 45, 47, 58, 66	882/1906	816/1857	0.16	0.21	0.430	–0.25	0.58	78.5
57	Self-monitoring	3a, 4, 6, 8, 10, 12, 21a, 31, 37, 50	781/1898	842/1734	0.44*	0.21	0.039^c,e,f,g	0.02	0.86	78.3
58	Shared decision making	6, 29, 37, 38a, 46	348/2440	342/2331	0.13	0.29	0.657	–0.45	0.70	78.4
58.1	Shared decision making – supervisor	6, 37, 38a, 46	299/2489	299/2374	0.05	0.32	0.876	–0.59	0.69	78.3
58.2	Shared decision making – other	29, 46	80/2708	72/2601	0.26	0.44	0.558	–0.62	1.14	78.5
59	Sleep management	37	164/2624	180/2493	–0.03	0.58	0.953	–1.19	1.12	78.2
60	Strength	1, 3a, 4, 6, 7a, 10, 11a, 12, 13a, 14, 15, 20, 21a, 27, 29, 30a, 31, 39a, 42, 47, 50, 62, 64a, 66	1688/1100	1642/1031	0.29	0.17	0.098^f,g	–0.06	0.64	76.3
61	Summarizing	10, 31, 38a	242/2546	230/2443	0.46	0.35	0.196	–0.25	1.17	78.2
62	Support	1, 3a, 8, 10, 13a, 16, 21a, 29, 31, 45, 46	754/2034	794/1879	0.38	0.20	0.069^h	–0.03	0.79	77.2
62.1	Support – peer	13a, 16	255/2533	279/2394	0.06	0.43	0.886	–0.80	0.93	78.1
62.2	Support – supervisor	3a, 8, 13a, 16, 21a, 29, 31, 45	676/2112	720/1953	0.30	0.23	0.207	–0.17	0.76	77.5
62.3	Support – others	1, 8, 10, 29, 46	268/2299	288/2127	0.39	0.29	0.179	–0.19	0.96	78.0
63	Tailoring	1, 3a, 4, 6, 8, 10, 11a, 12, 13a, 14, 16, 27, 29, 31, 37, 38a, 39a, 42, 44, 46, 47, 49, 50, 53, 58, 62, 65a, 66	2348/413	2279/363	0.52*	0.18	0.006^g	0.16	0.87	75.4
64	Vestibular	15, 31, 64a	174/2614	172/2501	0.04	0.37	0.924	–0.72	0.79	78.5
65	Visual	29	49/2739	43/2630	0.39	0.60	0.523	–0.82	1.60	78.5
66	Visualization	17	12/2776	8/2665	0.45	0.73	0.545	–1.03	1.92	78.5
67	Walking strategies	1, 6, 10, 11a, 12, 45, 47, 59a, 60a, 60b, 64a	408/2346	361/2291	0.17	0.22	0.449	–0.27	0.61	78.6
68	Warm-up	4, 11a, 13a, 15, 16, 19a, 20, 27, 28, 30a, 34, 36a, 47, 62, 63, 64a	798/1990	777/1896	–0.22	0.19	0.262	–0.60	0.17	78.4

* p < 0.05.

^a See supplementary file 3 for a detailed description of intervention components.

^b Significance changes in sensitivity analysis I, when repeating the meta-regressions with the second intervention arm of a study.

^c Significance changes in sensitivity analysis I, when repeating the meta-regressions with the third intervention arm of a study.

^d Significance changes in sensitivity analysis II, when removing cluster RCTs from the analysis.

^e Significance changes in sensitivity analysis III, when performing meta-regressions with the results of the latest available assessment.

^f Significance changes in sensitivity analysis V, when restricting analyses to studies with the best study quality (two high risk bias items).

^g Significance changes in sensitivity analysis VII, when removing outliers from the meta-regressions.

^h Significance changes in sensitivity analysis VIII, combining support and motivation.

ⁱ Intervention components that were distinguishable from intervention texts, but insufficiently explained to know what was meant for certain.

Moher D, Liberati A, Tetzlaff J, et al. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009;6(7):e1000097.

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Data availability statement

The data that support the findings of this study are openly available in Open Science Framework at https://doi.org/10.17605/OSF.IO/SF67D.