BACKGROUND: Falls are a leading cause of injuries in older adults, often resulting from slipping and tripping. Perturbation-based balance training (PBT) applied on treadmills is an emerging task-specific approach to falls prevention but standardized training protocols are lacking. This review presents an overview of PBT protocols on treadmills, their theoretical justification and proposes recommendations for standardized reporting. - METHODS: A systematic search was conducted in PubMed, Embase, Web of Science, CINAHL, CENTRAL and Clinical Trials Registration on May 9, 2025 to identify RCTs, pilot studies, study protocols and trial registrations on treadmill-based PBT for falls prevention in healthy older adults or those diagnosed with stroke, Parkinson’s disease or multiple sclerosis. Studies were screened by two independent researchers. Data on general and PBT specific training parameters as well as the justification for those parameters were narratively synthesized. - RESULTS: 1253 studies were identified. The eligibility criteria were met by 69 publications referring to 36 research projects. In total, 1928 participants were included, with 950 participants in the PBT groups. The training periods lasted from a single session to 12 weeks, including one to three sessions per week, each from 20 to 60 min. During standing and walking, from 24 up to 160 unannounced perturbations were induced, consisting of treadmill belt acceleration and deceleration as well as lateral displacements. Training intensity was often individually adjusted based on participant performance or subjective feedback, though methods varied widely. Perturbation frequency timing and the perturbed leg, as well as the theoretical justification for the training parameters were rarely reported. - CONCLUSIONS: The results reveal a high heterogeneity in the PBT protocols. Furthermore, training parameters and their justification were insufficiently reported in many studies. Therefore, we propose a reporting standard for PBT protocols (ProRePBT) to increase comparability between studies, improve replicability, and facilitate implementation into clinical practice. - SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12877-026-07124-3.
BMC geriatrics London : BioMed Central, 2001 26(2026), Artikel-ID 300, Seite 1-17 Online-Ressource
Lithium is regarded as the first-line treatment for bipolar disorder (BD), a severe and disabling mental health disorder that affects about 1% of the population worldwide. Nevertheless, lithium is not consistently effective, with only 30% of patients showing a favorable response to treatment. To provide personalized treatment options for bipolar patients, it is essential to identify prediction biomarkers such as polygenic scores. In this study, we developed a polygenic score for lithium treatment response (Li+PGS) in patients with BD. To gain further insights into lithium’s possible molecular mechanism of action, we performed a genome-wide gene-based analysis. Using polygenic score modeling, via methods incorporating Bayesian regression and continuous shrinkage priors, Li+PGS was developed in the International Consortium of Lithium Genetics cohort (ConLi+Gen: N = 2367) and replicated in the combined PsyCourse (N = 89) and BipoLife (N = 102) studies. The associations of Li+PGS and lithium treatment response — defined in a continuous ALDA scale and a categorical outcome (good response vs. poor response) were tested using regression models, each adjusted for the covariates: age, sex, and the first four genetic principal components. Statistical significance was determined at P < 0.05. Li+PGS was positively associated with lithium treatment response in the ConLi+Gen cohort, in both the categorical (P = 9.8 × 10−12, R2 = 1.9%) and continuous (P = 6.4 × 10−9, R2 = 2.6%) outcomes. Compared to bipolar patients in the 1st decile of the risk distribution, individuals in the 10th decile had 3.47-fold (95%CI: 2.22-5.47) higher odds of responding favorably to lithium. The results were replicated in the independent cohorts for the categorical treatment outcome (P = 3.9 × 10−4, R2 = 0.9%), but not for the continuous outcome (P = 0.13). Gene-based analyses revealed 36 candidate genes that are enriched in biological pathways controlled by glutamate and acetylcholine. Li+PGS may be useful in the development of pharmacogenomic testing strategies by enabling a classification of bipolar patients according to their response to treatment.
