INTERVENTION RESEARCH
Interventions for Falls Efficacy
Supporting people not only to reduce the risk of falling, but also to develop the perceived and physical capability to respond when balance is disturbed, manage a fall safely, and recover afterwards.
Falls efficacy is multidimensional. Intervention therefore requires more than a single exercise or strategy. The appropriate approach depends on the individual, their capabilities, the fall-related situation and the intended therapeutic goal.
CLINICAL PERSPECTIVE
Beyond Fall Prevention
Strength and balance training remain important components of falls prevention. However, fall-related capability extends beyond maintaining stability during everyday activities.
People may also need the capability to recover from an unexpected loss of balance, protect themselves if a fall becomes unavoidable, and manage the situation after reaching the ground.
PHYSICAL
Build capability
Address strength, balance, mobility, reactive responses, movement strategies and functional recovery where appropriate.
PSYCHOLOGICAL
Build confidence
Consider perceived capability, fear or concern about falling, avoidance and willingness to engage in meaningful activity.
PERSON-CENTRED
Match the intervention
Intervention choice should reflect individual needs, goals, abilities, health status, environment and the specific fall-related challenge.
FOUR-STAGE APPROACH
Intervening Across the Falls Journey
Different stages of a fall-related event present different therapeutic challenges. The examples below represent potential intervention targets rather than a universal treatment prescription.
PRE-FALL
Maintain Stability
Balance confidence
Develop the physical and perceived capability to remain steady during meaningful activities.
NEAR-FALL
Recover Agility
Balance recovery confidence
Develop reactive responses when balance has already been disturbed by a slip, trip or other perturbation.
FALL-LANDING
Manage the Landing
Safe-landing confidence
Where appropriate and safely supervised, training may include strategies intended to protect the body when a fall cannot be arrested.
COMPLETED FALL
Recover After the Fall
Post-fall recovery confidence
Support the capability to manage the immediate situation after a fall, including getting up or obtaining assistance.
NEAR-FALL INTERVENTION
Reactive Balance Training
Reactive balance training deliberately challenges the ability to respond to unexpected losses of balance. This differs from conventional steady-state balance exercise because a rapid corrective response is required after stability has already been disturbed.
Systematic-review evidence suggests that reactive balance training can reduce falls in some older adults and people with balance impairments. However, protocols vary considerably and the optimal type, dose and progression of training remain uncertain.
POTENTIAL TRAINING ELEMENTS
Training involving perturbations should be appropriately screened, supervised and conducted within a safe clinical or research environment.
FALL-LANDING INTERVENTION
Preparing for an Unavoidable Fall
Some intervention approaches explore whether people can be taught strategies for managing the landing phase of a fall. Examples include breakfall or ukemi techniques, rolling strategies and other protective movement patterns.
This remains an evolving area of research. Training should not be assumed to be appropriate for every older adult or clinical population and should be delivered with appropriate safety considerations.
SAFE-LANDING RESOURCE
Safe-landing Techniques
Explore the dedicated Falls Efficacy resource describing approaches such as falling-slaps, rolling strategies and combinations of protective techniques.
COMPLETED-FALL INTERVENTION
Getting Up After a Fall
The ability to rise from the floor is an important aspect of post-fall recovery. Potential intervention approaches include strengthening, practising the task of getting up, and teaching alternative movement sequences.
A mixed-method systematic review by Burton and colleagues included 41 studies. Resistance training and teaching floor-rise skills were commonly used, but pooled randomised-trial evidence did not demonstrate a clear overall improvement in floor-rise time. Further research into specific techniques and task practice remains needed.
THERAPEUTIC PERSPECTIVE
Therapeutic Falls Efficacy
Therapeutic Falls Efficacy provides a clinical reasoning perspective for considering both confidence and capability across different stages of a fall-related situation.
It is not a single standardised intervention protocol. Rather, it encourages clinicians and researchers to identify the relevant fall-related challenge and consider how psychological and physical capability might be addressed together.
ASSESS
Understand the person
Identify the relevant fall-related situation, perceived capability, physical performance, goals and context.
TARGET
Identify the gap
Determine whether intervention should primarily address physical capability, perceived capability, or both.
PRACTISE
Build meaningful capability
Use appropriately challenging, person-centred practice that reflects the functional situation being addressed.
REASSESS
Review confidence and performance
Evaluate whether perceived capability and observable function change together or remain discordant.
EVIDENCE LANDSCAPE
Different Intervention Targets Require Different Evidence
Falls-efficacy outcomes have been examined across a wide variety of interventions. However, an intervention that improves one fall-related outcome should not automatically be assumed to improve every dimension of falls efficacy.
PRE-FALL
Strength, balance and multicomponent interventions
These approaches predominantly target physical capacity, balance and fall prevention. Psychological outcomes may also be measured, but the construct represented should be interpreted carefully.
NEAR-FALL
Reactive and perturbation-based balance training
Research increasingly examines task-specific responses to destabilisation and whether these approaches influence reactive balance and real-world falls.
Review evidence →FALL-LANDING
Safe-falling and protective strategies
Judo-derived, breakfall and other safe-landing approaches are being investigated, but the evidence base is smaller and safety, transferability and population suitability require careful consideration.
COMPLETED FALL
Floor-rise and fall-recovery training
Research includes resistance training, movement-strategy teaching and direct floor-rise practice. Evidence for the optimal approach remains incomplete.
Review evidence →EVIDENCE ARCHIVE
Intervention Evidence Map
The original Falls Efficacy intervention resource catalogued a broad range of randomised trials and related studies, including exercise, Tai Chi, perturbation training, cognitive-behavioural approaches, multicomponent programmes, environmental modification and technology-assisted interventions.
This historical catalogue is useful for identifying the breadth of intervention research, but should not be interpreted as a current systematic review or as evidence that all listed approaches have equivalent effects.
View representative intervention categories
EMERGING APPROACHES
Digital Health and Movement Technology
Digital tools may support assessment, exercise delivery, movement monitoring, feedback and progression. Their value depends on clinical relevance, usability, safety, workflow fit and the quality of supporting evidence.
CLINICAL REASONING
Start With the Individual, Not the Intervention
A useful intervention begins by identifying the individual’s needs and the specific capability that requires attention. Falls efficacy should therefore be considered alongside physical performance, health status, environmental context and meaningful activity goals.
What is the problem?
Difficulty maintaining balance, recovering from perturbation, landing safely, getting up, or a combination?
What does the person believe?
Is confidence appropriately matched to physical capability?
What can the person do?
Consider objective physical performance and functional capacity.
What matters to them?
Intervention should support meaningful and safe participation rather than simply improving a test score.
EXPLORE
Continue Exploring
Advance Falls Prevention and Management
We welcome collaboration involving intervention development, rehabilitation, falls efficacy, reactive balance, safe-falling strategies and post-fall recovery.