Effect of Perturbation-Based Balance Training on Fear of Falling After Lower-Limb Orthopaedic Surgery

Abstract—Fear of falling (FoF) is common after hip fracture and hip or knee arthroplasty and can restrict mobility during the very period in which rehabilitation depends on it. Perturbation-based balance training (PBT) trains reactive balance by exposing patients to repeated, unexpected, safely controlled losses of balance. It reduces falls in older adults, yet its effect on FoF is uncertain: it may build mastery and reduce threat appraisal, or it may provoke anxiety. This paper (i) synthesises current evidence on FoF and falls after lower-limb orthopaedic surgery and on PBT, (ii) proposes a mechanistic model of how PBT could alter FoF, and (iii) presents a registered-trial-ready protocol for an assessor-blinded randomised controlled trial (RCT) comparing six sessions of PBT with attention-matched conventional balance training (planned N = 152; primary outcome Falls Efficacy Scale-International, FES-I). The evidence reviewed shows a high burden of FoF and falls after surgery and a growing body of PBT trials in community-dwelling older adults, but no completed RCT in postorthopaedic patients was identified, and the only trial reviewed that reported FES-I found no change. No participant data were collected for this paper; the results section therefore sets out testable hypotheses and interpretation rules rather than findings.