Effectiveness of Physical Therapy Interventions in Reducing Fear of Falling Among Individuals With Neurologic Diseases: A Systematic Review and Meta-analysis.

Fear of falling is common among people living with neurologic conditions and can itself limit mobility and quality of life, so researchers wanted to know whether physical therapy programs actually help reduce it. This systematic review and meta-analysis pooled 61 trials involving nearly 4,000 participants with conditions including Parkinson disease, multiple sclerosis, stroke, and spinal cord injury, comparing different exercise and training approaches against each other or against usual care. The results were mixed depending on the condition. In Parkinson disease, adding balance training to gait training produced a statistically significant improvement over gait training alone.

In multiple sclerosis, home-based or leisure exercise significantly outperformed usual care. But for stroke and spinal cord injury, no statistically significant differences were found between interventions. The authors rated the overall certainty of evidence as very low to moderate, reflecting the risk of bias across studies, which means these findings should be seen as encouraging in certain conditions but far from settled overall.

If you or someone you know lives with a neurologic condition like Parkinson disease, multiple sclerosis, stroke, or spinal cord injury, fear of falling can be just as limiting as the physical symptoms themselves, sometimes causing people to avoid activity altogether. This review looked at many studies testing whether physical therapy programs could ease that fear. For people with Parkinson disease, combining gait training with balance training showed a statistically significant improvement in reducing fear of falling compared to gait training by itself.

For people with multiple sclerosis, home-based or leisure exercise programs showed significant improvement compared to usual care. However, for stroke and spinal cord injury, the studies did not find clear differences between treatment approaches. It's important to know that the overall quality of evidence behind these findings ranges from very low to moderate, meaning researchers have only limited confidence in some results.

This doesn't mean physical therapy doesn't help, but rather that more rigorous research is still needed before firm conclusions can be drawn for every condition.

This is a summary of research, not medical advice. Talk to your own healthcare provider about anything affecting your care.

For clinicians weighing how to structure rehabilitation for fear of falling across neurologic populations, this review and meta-analysis pools 61 trials (53 included in meta-analysis, 3,524 participants) spanning Parkinson disease, multiple sclerosis, stroke, and spinal cord injury, offering condition-specific signals rather than a single blanket answer. The clearest statistically significant findings were a gait-plus-balance training combination outperforming gait training alone in Parkinson disease (mean difference 11.80, 95% CI 8.22-15.38) and home-based or leisure exercise outperforming usual care in multiple sclerosis (mean difference 15.27, 95% CI 6.15-24.38).

No statistically significant between-group differences emerged for stroke or spinal cord injury, meaning the review does not establish that any tested intervention reduces fear of falling in those populations specifically. Since multiple sclerosis comparisons involved usual care as the control, the possibility that increased therapist contact or attention contributed to the benefit cannot be excluded. The authors rate overall evidence quality via GRADE as ranging from very low to moderate, and included studies carried low to high risk of bias, so these condition-specific findings should inform clinical reasoning as suggestive rather than definitive, particularly given the heterogeneity of included study designs and outcome measures.