The effectiveness of e-interventions on fall, neuromuscular functions and quality of life in community-dwelling older adults: A systematic review and meta-analysis

Background: Falls in older adults result in serious, life-limiting consequences. An increasing number of fall prevention interventions have used technology to reduce the number of falls in community-dwelling adults. Various types of e-interventions are being tested in clinical trials and in the community. These include telehealth, exergames, cognitive games, socialized training, smart home systems and non-conventional balance training. Currently, no systematic review and meta-analysis has assessed the overall effectiveness of e-interventions and compared the effectiveness of the different types. Objectives: The aim of this review was to synthesize best available evidence concerning the effectiveness of e-interventions on fall, neuromuscular functions and quality of life in community-dwelling older adults. Methods: A rigorous three-step search was conducted in nine online databases for published and unpublished randomized controlled trials studying e-interventions. Studies were screened and assessed for individual and overall risk of bias by two independent reviewers. Six fall-related outcomes were evaluated in the meta-analysis: fall risk, balance, lower extremity strength, fall efficacy, cognitive function and health-related quality of life. Subgroup and sensitivity analysis were conducted during meta-analysis. Results: Thirty-one studies fit the eligibility criteria and had an overall 74.7% low risk of bias. A total of 4,877 older adults from 17 countries were included in narrative synthesis and meta-analysis. Telehealth combined with exercise programmes and smart home systems were able to reduce fall risk significantly (risk ratio=0.79, 95% CI [0.72, 0.86]). E-interventions also significantly improved balance and fall efficacy (standardized mean difference=0.28, 95% CI [0.04, 0.53]). However, lower extremity strength, cognitive function and health-related quality of life did not show significant improvements. Conclusion: Telehealth combined with exercise and smart home systems demonstrated the best evidence of effectiveness in reduction of falls in community-dwelling older adults. Future research should focus on forecasting falls using smart home technology and Artificial Intelligence, and testing promising einterventions on larger samples to improve the strength of evidence of fall prevention by e-interventions. (C) 2020 Elsevier Ltd. All rights reserved.