Association of lower-limb strength with different fall histories or prospective falls in community-dwelling older people: a systematic review and meta-analysis

Background: Fall is a major health threat to older people. The lower-limb power and rate of torque or force development (RTD or RFD) are prominently affected by aging and are crucial for maintaining postural balance. However, there have been inconsistent findings regarding the association of such aspects of lower-limb strength with falls among community-dwelling older adults. Comprehensive synthesis and appraisal are needed to examine what deficits in lower-limb rapid force generation could identify the fallers (i.e., those with a fall history or prospective falls). Methods: This systematic review searched six databases, including PubMed, Web of Science, EMBASE, Scopus, CINAHL, and Cochrane CENTRAL. Meta-analysis was conducted to aggregate standardized mean differences (SMD) or odds ratios (OR). The quality of evidence regarding each strength parameter’s ability to identify fallers was assessed using the GRADE approach. Results: Twenty observational studies with 8,231 community-dwelling older adults were included (mean age: 73.5 years; male to female ratio: approximately 6:1). Moderate quality of evidence showed that the lower average leg-press power (SMD & 95% CI: -0.17 [-0.23, -0.12]; OR & 95% CI: 0.84 [0.79, 0.89]) and lower peak sit-to-stand power (Cohen’s d = 0.41) could predict prospective falls in older adults, especially the injurious/recurrent falls. Low quality of evidence showed that the lower peak sit-to-stand power could also discern fall history (SMD & 95% CI: -0.58 [-0.96, -0.20]). Conversely, low to very low quality of evidence showed that the RTD of a single muscle group could not predict prospective falls and was generally unable to identify fall history in older adults. Discussions and Conclusion: The decline of entire lower-limb power appears a good indicator of prospective falls in community-dwelling older adults. Tests of entire lower-limb power required the cumulative and coordinated contractions of more leg muscles, possibly explaining why they could identify the fallers whereas the RTD or power of a single muscle group could not. Future studies are warranted to determine cut-point values of the entire lower-limb power measurements in fall-risk assessment and explore rapid force generation of a single muscle group in predicting the injurious falls among older adults. Trial registration: Registration No.: CRD42021237091.