EFFECTS OF BALANCE TRAINING ON BALANCE AND FALL EFFICACY IN PATIENTS WITH OSTEOPOROSIS: A SYSTEMATIC REVIEW AND META-ANALYSIS WITH TRIAL SEQUENTIAL ANALYSIS

Objective: To appraise research evidence on the effects of balance training on balance and fall efficacy in patients with osteoporosis. Methods: Six electronic databases were searched from inception of the database to 1 August 2022, with no language restrictions, and randomized controlled trials of balance training in patients with osteoporosis were included in this meta-analysis. Two authors independently screened and reviewed the articles and assessed the methodological quality using the Cochrane risk-of-bias tools. Trial sequential analysis was conducted. Results: A total of 10 randomized controlled trials with 684 patients were included. Three of the studies that were included had low risk of bias, 5 had moderate risk of bias, and 2 had high risk of bias. A meta-analysis demonstrated that balance training improves dynamic balance measured using the Timed Up and Go Test (mean difference (MD) = -1.86, 95% CI (-2.69, -1.02), Z = 4.38, p< 0.0001) and the Berg Balance Scale (MD = 5.31, 95% CI (0.65, 9.96), Z= 2.23, p < 0.03), static balance measured using One-Leg Standing Time (MD = 4.10, 95% CI (2.19, 6.01), Z= 4.21, p < 0.0001), and fall efficacy measured using the Falls Efficacy Scale International (MD = -4.60, 95% CI (-6.33, -2.87), Z = 5.20, p < 0.00001) were also significantly improved. Trial sequential analysis showed reliable evidence of the effects of balance training on dynamic and static balance improvement. The conclusions of this review are supported by the statistical and clinical significance of all outcomes in the meta-analysis, based on the advised minimal clinically significant differences and minimum detectable changes. Conclusion: Balance training may be effective in improving balance ability and reducing fear of falling in patients with osteoporosis.