Effectiveness 0f Feldenkrais Exercises and Otago Exercises on Balance and Prevention of Fall In Older Adults: A Systematic Review And Comparative Evidence Synthesis

Abstract

Falls are an important contributor to morbidity, functional decline, and loss of independence, disability, and poor quality of life among older adults. Impaired postural control, diminished lower-extremity strength, changed gait, reduced movement confidence, sensory-motor impairments and fear of falling are key modifiable fall risk factors. Therefore, exercise-based therapies are a key component of geriatric rehabilitation and fall-prevention methods. The Feldenkrais Method (FM) is a movement-education approach that emphasizes sensory awareness, postural organization, coordination, movement variability and efficient motor control, while the Otago Exercise Program (OEP) is a structured fall-prevention program consisting of progressive lower-limb strengthening, balance training and walking.
The aim of this systematic review was to synthesize the current evidence for the effectiveness of Feldenkrais and Otago exercises on balance, functional mobility, gait, balance confidence, fear of falling and fall prevention in older adults and compare the level and clinical relevance of the evidence for each intervention.
Feldenkrais-based therapies were found to have positive impacts on balance-related metrics, gait, functional mobility, movement awareness, comfort, and balance confidence. However, the data was varied and several studies included indirect groups. Interventions based in Otago were consistently reporting the gains in balance and functional mobility and somewhat stronger evidence in respect of actual fall prevention especially in community dwelling older persons. Delivery of OEP in groups proved to have equivalent fall-prevention effects to programs administered to individuals. Thus no superiority of any intervention can be demonstrated. To summarize, OEP provides higher intervention-specific evidence for fall prevention while Feldenkrais appears to be particularly effective for sensory-motor awareness, postural organization, balance confidence and functional mobility. Future head-to-head trials with suitable power should directly evaluate these treatments and see if a combined intervention adds any benefits.