The effectiveness of multimodal physiotherapy in preventing falls among community-dwelling older adults in the U.S

Objective: To evaluate the effectiveness and cost-effectiveness of multimodal physiotherapy comprising balance, strength, gait, and functional training in preventing falls among community-dwelling adults aged ≥65 in the U.S., with implications for national implementation. Methods: MEDLINE, Embase, CINAHL, and Cochrane were searched (2000–April 2025) for randomized controlled trials (RCTs) and economic evaluations. Studies included ≥2 exercise modalities, had community-dwelling populations≥65 years, and reported falls, injurious falls, functional outcomes, QALYs, or costs. Meta-analysis used a random-effects model. Results: Seventeen RCTs (n = 5,425) and eight economic evaluations were included. The combined effect on fall risk yielded an incidence rate ratio (IRR) of 0.72 (95% CI [0.62, 0.83]), a 28% reduction. Injurious falls decreased (rate ratio = 0.63 [0.51, 0.77]). Incremental costs averaged US$786 per person, with negligible QALY gain (0.00 [–0.04, 0.04]); unimodal resistance exercise was more cost-effective (IRR = 0.72, cost = US $128, QALY = 0.09). Conclusions: Multimodal physiotherapy significantly reduces falls and fall-related injuries. Although cost-effective under conventional thresholds, resistance-only programs offer better value. U.S. implementation should target high-risk older adults, leverage group models, and align with CMS and CDC fall-prevention initiatives.