Association of lower-limb strength with different fall histories or prospective falls in community-dwelling older people: a systematic review and meta-analysis
Abstract Background Fall is a major health threat to older people. The lower-limb power and rate of torque or force development (RTD or RFD) are prominently affected by aging and are crucial for maintaining postural balance. However, there have been inconsistent findings regarding the association of...
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BMC
2025-02-01
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| Series: | BMC Geriatrics |
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| Online Access: | https://doi.org/10.1186/s12877-025-05685-3 |
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| author | Ringo Tang-Long Zhu Jenny Jing-Jing Zuo Ke-Jing Li Freddy Man Hin Lam Arnold Yu Lok Wong Lin Yang Xue Bai Man Sau Wong Timothy Kwok Yong-Ping Zheng Christina Zong-Hao Ma |
| author_facet | Ringo Tang-Long Zhu Jenny Jing-Jing Zuo Ke-Jing Li Freddy Man Hin Lam Arnold Yu Lok Wong Lin Yang Xue Bai Man Sau Wong Timothy Kwok Yong-Ping Zheng Christina Zong-Hao Ma |
| author_sort | Ringo Tang-Long Zhu |
| collection | DOAJ |
| description | Abstract Background Fall is a major health threat to older people. The lower-limb power and rate of torque or force development (RTD or RFD) are prominently affected by aging and are crucial for maintaining postural balance. However, there have been inconsistent findings regarding the association of such aspects of lower-limb strength with falls among community-dwelling older adults. Comprehensive synthesis and appraisal are needed to examine what deficits in lower-limb rapid force generation could identify the fallers (i.e., those with a fall history or prospective falls). Methods This systematic review searched six databases, including PubMed, Web of Science, EMBASE, Scopus, CINAHL, and Cochrane CENTRAL. Meta-analysis was conducted to aggregate standardized mean differences (SMD) or odds ratios (OR). The quality of evidence regarding each strength parameter’s ability to identify fallers was assessed using the GRADE approach. Results Twenty observational studies with 8,231 community-dwelling older adults were included (mean age: 73.5 years; male to female ratio: approximately 6:1). Moderate quality of evidence showed that the lower average leg-press power (SMD & 95% CI: -0.17 [-0.23, -0.12]; OR & 95% CI: 0.84 [0.79, 0.89]) and lower peak sit-to-stand power (Cohen’s d = 0.41) could predict prospective falls in older adults, especially the injurious/recurrent falls. Low quality of evidence showed that the lower peak sit-to-stand power could also discern fall history (SMD & 95% CI: -0.58 [-0.96, -0.20]). Conversely, low to very low quality of evidence showed that the RTD of a single muscle group could not predict prospective falls and was generally unable to identify fall history in older adults. Discussions and Conclusion The decline of entire lower-limb power appears a good indicator of prospective falls in community-dwelling older adults. Tests of entire lower-limb power required the cumulative and coordinated contractions of more leg muscles, possibly explaining why they could identify the fallers whereas the RTD or power of a single muscle group could not. Future studies are warranted to determine cut-point values of the entire lower-limb power measurements in fall-risk assessment and explore rapid force generation of a single muscle group in predicting the injurious falls among older adults. Trial registration Registration No.: CRD42021237091. |
| format | Article |
| id | doaj-art-c8cd053d048b412ab6bacf39710f5479 |
| institution | Kabale University |
| issn | 1471-2318 |
| language | English |
| publishDate | 2025-02-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Geriatrics |
| spelling | doaj-art-c8cd053d048b412ab6bacf39710f54792025-02-09T12:53:29ZengBMCBMC Geriatrics1471-23182025-02-0125113810.1186/s12877-025-05685-3Association of lower-limb strength with different fall histories or prospective falls in community-dwelling older people: a systematic review and meta-analysisRingo Tang-Long Zhu0Jenny Jing-Jing Zuo1Ke-Jing Li2Freddy Man Hin Lam3Arnold Yu Lok Wong4Lin Yang5Xue Bai6Man Sau Wong7Timothy Kwok8Yong-Ping Zheng9Christina Zong-Hao Ma10Department of Biomedical Engineering, The Hong Kong Polytechnic UniversityDepartment of Biomedical Engineering, The Hong Kong Polytechnic UniversityDepartment of Biomedical Engineering, The Hong Kong Polytechnic UniversityDepartment of Rehabilitation Sciences, The Hong Kong Polytechnic UniversityResearch Institute for Smart Ageing, The Hong Kong Polytechnic UniversitySchool of Nursing, The Hong Kong Polytechnic UniversityResearch Institute for Smart Ageing, The Hong Kong Polytechnic UniversityResearch Institute for Smart Ageing, The Hong Kong Polytechnic UniversityDepartment of Medicine & Therapeutics, The Chinese University of Hong KongDepartment of Biomedical Engineering, The Hong Kong Polytechnic UniversityDepartment of Biomedical Engineering, The Hong Kong Polytechnic UniversityAbstract Background Fall is a major health threat to older people. The lower-limb power and rate of torque or force development (RTD or RFD) are prominently affected by aging and are crucial for maintaining postural balance. However, there have been inconsistent findings regarding the association of such aspects of lower-limb strength with falls among community-dwelling older adults. Comprehensive synthesis and appraisal are needed to examine what deficits in lower-limb rapid force generation could identify the fallers (i.e., those with a fall history or prospective falls). Methods This systematic review searched six databases, including PubMed, Web of Science, EMBASE, Scopus, CINAHL, and Cochrane CENTRAL. Meta-analysis was conducted to aggregate standardized mean differences (SMD) or odds ratios (OR). The quality of evidence regarding each strength parameter’s ability to identify fallers was assessed using the GRADE approach. Results Twenty observational studies with 8,231 community-dwelling older adults were included (mean age: 73.5 years; male to female ratio: approximately 6:1). Moderate quality of evidence showed that the lower average leg-press power (SMD & 95% CI: -0.17 [-0.23, -0.12]; OR & 95% CI: 0.84 [0.79, 0.89]) and lower peak sit-to-stand power (Cohen’s d = 0.41) could predict prospective falls in older adults, especially the injurious/recurrent falls. Low quality of evidence showed that the lower peak sit-to-stand power could also discern fall history (SMD & 95% CI: -0.58 [-0.96, -0.20]). Conversely, low to very low quality of evidence showed that the RTD of a single muscle group could not predict prospective falls and was generally unable to identify fall history in older adults. Discussions and Conclusion The decline of entire lower-limb power appears a good indicator of prospective falls in community-dwelling older adults. Tests of entire lower-limb power required the cumulative and coordinated contractions of more leg muscles, possibly explaining why they could identify the fallers whereas the RTD or power of a single muscle group could not. Future studies are warranted to determine cut-point values of the entire lower-limb power measurements in fall-risk assessment and explore rapid force generation of a single muscle group in predicting the injurious falls among older adults. Trial registration Registration No.: CRD42021237091.https://doi.org/10.1186/s12877-025-05685-3Community-dwelling older adultsFallsFallersRisk factorsFall incidenceFall history |
| spellingShingle | Ringo Tang-Long Zhu Jenny Jing-Jing Zuo Ke-Jing Li Freddy Man Hin Lam Arnold Yu Lok Wong Lin Yang Xue Bai Man Sau Wong Timothy Kwok Yong-Ping Zheng Christina Zong-Hao Ma Association of lower-limb strength with different fall histories or prospective falls in community-dwelling older people: a systematic review and meta-analysis BMC Geriatrics Community-dwelling older adults Falls Fallers Risk factors Fall incidence Fall history |
| title | Association of lower-limb strength with different fall histories or prospective falls in community-dwelling older people: a systematic review and meta-analysis |
| title_full | Association of lower-limb strength with different fall histories or prospective falls in community-dwelling older people: a systematic review and meta-analysis |
| title_fullStr | Association of lower-limb strength with different fall histories or prospective falls in community-dwelling older people: a systematic review and meta-analysis |
| title_full_unstemmed | Association of lower-limb strength with different fall histories or prospective falls in community-dwelling older people: a systematic review and meta-analysis |
| title_short | Association of lower-limb strength with different fall histories or prospective falls in community-dwelling older people: a systematic review and meta-analysis |
| title_sort | association of lower limb strength with different fall histories or prospective falls in community dwelling older people a systematic review and meta analysis |
| topic | Community-dwelling older adults Falls Fallers Risk factors Fall incidence Fall history |
| url | https://doi.org/10.1186/s12877-025-05685-3 |
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