OBJECTIVE To summarize the effectiveness of physical therapy (PT) interventions to reduce fear of falling (FOF) among individuals living with neurological diseases. DATA SOURCES PubMed, PEDro, Scopus, Web of Science, PsycINFO, CINAHL, and SportDiscuss were searched from inception until December 2019. STUDY SELECTION Clinical trials with either the primary or secondary aim to reduce FOF among adults with neurological diseases were selected. DATA EXTRACTION Potential papers were screened for eligibility and data extracted by two independent researchers. Risk of bias was assessed by the Cochrane Risk of Bias tool for randomized clinical trials and the NIH Quality Assessment Tool for pre-post studies. A meta-analysis was performed among trials presenting with similar clinical characteristics. The Grading Recommendations, Assessment, Development and Evaluation- GRADE was used to rate the overall quality of evidence. RESULTS Sixty-one trials/3954 participants were included in the review and 53 trials/3524 participants in the meta-analysis. The included studies presented, in general, with a low to high risk of bias. A combination of gait and balance training was found to be significantly more effective compared to gait training alone in reducing FOF among individuals with Parkinson's Disease (PD) (Mean Difference- MD = 11.80, 95% CI, 8.22 - 15.38; p < 0.001). Home-based exercise and leisure exercise demonstrated significant improvement in reducing FOF over usual care in multiple sclerosis (MS) (MD = 15.27, 95% CI, 6.15 - 24.38, p = 0.001). No statistically significant between-groups differences were reported among individuals with stroke and spinal cord injury (SCI). The overall quality of evidence presented in this review ranges from very low to moderate according to the assessment with the GRADE approach. CONCLUSION Gait with lower limb training combined with balance training is effective in reducing FOF in individuals with PD. Also, home-based or leisure exercise is effective among individuals with MS. However, due to several limitations of the included studies, further research is needed to examine the effectiveness of FOF intervention among individuals with neurological diseases.

中文翻译：

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物理治疗干预在减少神经系统疾病患者跌倒恐惧方面的有效性：系统评价和荟萃分析

目的 总结物理治疗 (PT) 干预措施在减少神经系统疾病患者跌倒恐惧 (FOF) 方面的有效性。数据来源 PubMed、PEDro、Scopus、Web of Science、PsycINFO、CINAHL 和 SportDiscuss 从开始到 2019 年 12 月进行了搜索。 研究选择 选择了主要或次要目的是减少神经系统疾病成人 FOF 的临床试验。数据提取 筛选了潜在论文的资格和由两名独立研究人员提取的数据。偏倚风险通过用于随机临床试验的 Cochrane 偏倚风险工具和用于事前研究的 NIH 质量评估工具进行评估。在具有相似临床特征的试验中进行了荟萃分析。分级建议、评估、发展和评估 - GRADE 用于评估证据的整体质量。结果 61 项试验/3954 名参与者被纳入审查，53 项试验/3524 参与者被纳入荟萃分析。纳入的研究总体上呈现出从低到高的偏倚风险。与单独的步态训练相比，步态和平衡训练的组合在减少帕金森病 (PD) 患者的 FOF 方面显着更有效（平均差异 - MD = 11.80，95% CI，8.22 - 15.38；p < 0.001） . 与多发性硬化症 (MS) 的常规护理相比，家庭锻炼和休闲锻炼在减少 FOF 方面有显着改善（MD = 15.27，95% CI，6.15 - 24.38，p = 0.001）。中风和脊髓损伤 (SCI) 的个体之间没有报告统计学上显着的组间差异。根据 GRADE 方法的评估，本综述中提供的证据的总体质量从极低到中等不等。结论 下肢步态训练结合平衡训练可有效减少 PD 患者的 FOF。此外，家庭或休闲锻炼对 MS 患者有效。然而，由于纳入研究的一些局限性，需要进一步研究来检验 FOF 干预对神经系统疾病个体的有效性。家庭或休闲锻炼对 MS 患者有效。然而，由于纳入研究的一些局限性，需要进一步研究来检验 FOF 干预对神经系统疾病个体的有效性。家庭或休闲锻炼对 MS 患者有效。然而，由于纳入研究的一些局限性，需要进一步研究来检验 FOF 干预对神经系统疾病个体的有效性。