title: The effects of manual therapy on balance and falls: a systematic review.
abstract: OBJECTIVE
  The purpose of this study was to review the scientific literature on the effects of manual therapy interventions on falls and balance.
  
  
  METHODS
  This systematic review included randomized and quasi-randomized controlled trials that investigated the effects of manual therapy interventions on falls or balance. Outcomes of interest were rate of falls, number of fallers reported, and measures of postural stability. Data sources included searches through June 2011 of Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, MEDLINE, EMBASE, CINAHL, PsycINFO, Allied and Complimentary Medicine, Current Controlled Trials, Manual Alternative and Natural Therapy Index System, Index to the Chiropractic Literature, National Institutes of Health (USA), and Google Scholar.
  
  
  RESULTS
  Eleven trials were identified that met the inclusion criteria. Most trials had poor to fair methodological quality. All included trials reported outcomes of functional balance tests or tests that used a computerized balance platform. Nine of the 11 trials reported some statistically significant improvements relating to balance after an intervention that included a manual therapy component. The ability to draw conclusions from a number of the studies was limited by poor methodological quality or very low participant numbers. A meta-analysis was not performed due to heterogeneity of interventions and outcomes. Only 2 small trials included falls as an outcome measure, but as a feasibility study and a pilot study, no meaningful conclusions could be drawn about the effects of the intervention on falls.
  
  
  CONCLUSIONS
  A limited amount of research has been published that supports a role for manual therapy in improving postural stability and balance. More well-designed controlled trials with sufficient participant numbers are required to draw meaningful clinical conclusions about the role that manual therapies may play in preventing falls or improving postural stability and balance.
authors.affiliation: Research Department, New Zealand College of Chiropractic, Auckland, New Zealand. kelly.holt@nzchiro.co.nz
authors.forename: Kelly R
authors.initials: KR
authors.lastname: Holt
authors.forename: Heidi
authors.initials: H
authors.lastname: Haavik
authors.forename: C Raina
authors.initials: CR
authors.lastname: Elley
mesh_terms: D000058:Accidental Falls / Q000517:prevention & control*; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D015577:Geriatric Assessment; D006801:Humans; D008297:Male; D026882:Manipulation, Chiropractic / Q000379:methods*; D026201:Musculoskeletal Manipulations / Q000379:methods; D009520:New Zealand; D004856:Postural Balance / Q000502:physiology*; D016032:Randomized Controlled Trials as Topic; D018570:Risk Assessment; D012678:Sensation Disorders / Q000175:diagnosis / Q000628:therapy*; D016896:Treatment Outcome