Effect of Compensatory Stepping Training Versus Conventional Therapy on Balance Confidence in Older adults with High Risk of Falls: A Comparative Study

Background: Older adults at high risk of falls show impaired change-in-support (compensatory stepping) reactions, and reduced balance confidence both results from and predicts future falls. Task-specific, therapist-applied perturbation training has been proposed to improve reactive balance control, but comparative evidence against conventional balance therapy for balance confidence remains limited, particularly in Indian older adults. Objectives: This report addresses the first three objectives of a larger trial: to determine the effect of (1) Compensatory Stepping Training (CST) and (2) Conventional Therapy on balance confidence at 4 weeks, and (3) to compare the two interventions. Methods: In this two-arm, age-matched comparative study, 218 community-dwelling older adults (60–80 years) with a Timed Up and Go score ≥13.5 s were purposively allocated to Group A (CST, n=109) or Group B (Conventional, n=109). Group A received 4 weeks of therapist-applied multidirectional perturbation training superimposed on functional tasks; Group B received flexibility and functional strengthening exercises alone. Balance confidence was measured with the Activities-specific Balance Confidence (ABC) Scale at baseline (T1) and 4 weeks (T2). Results: Baseline age, gender, fall history and ABC scores were comparable between groups (all p>.05). ABC scores improved significantly within both groups (Group A: 53.4 to 68.4, +14.9 points, p<.001; Group B: 54.1 to 59.6, +5.5 points, p<.001). The improvement was significantly greater in Group A (p<.001, large effect size). Conclusion: Both interventions improved balance confidence over 4 weeks, but CST produced a substantially larger and clinically more meaningful improvement than conventional therapy in high-risk older adults. Abbreviations ABC: Activities-specific Balance Confidence; CST: Compensatory Stepping Training; TUG: Timed Up and Go; MMSE: Mini-Mental State Examination; SD: Standard Deviation; T1: Baseline; T2: Four Weeks