Effects of task-oriented training on balance, gait, and fall in older adults: A systematic review and meta-analysis of randomized controlled trials

BACKGROUND: Task-oriented training(TOT) is a rehabilitation approach focused on practicing goal-oriented, functional tasks. AIMS: To investigate the effects of TOT compared with conventional training on improving balance, gait, and fall prevention in older adults(aged ≥ 60 years). METHODS: The study was registered in PROSPERO(ID: CRD42025635269). We searched PubMed, Web of Science, Embase, and ClinicalTrials.gov up to October 2025 for eligible randomized controlled trials. Methodological quality was assessed using the PEDro scale and the Cochrane risk of bias tool. Statistical analyses were performed using Stata 18 and RevMan 5.4. Minimal clinically important difference(MCID) values were determined by reviewing relevant literature. RESULTS: Twenty studies were included, fifteen of which with complete data were meta-analyzed. Compared to conventional training, TOT was more effective in improving Berg Balance Scale (BBS)(MD = 2.58, P < 0.001), Timed Up and Go test (TUG test)(MD = -0.55, P < 0.001), gait speed (GS)(MD = 0.14, P < 0.001), and Activities-specific Balance Confidence Scale(MD = 17.06, P < 0.001). Improvements in BBS, TUG test and GS for individuals aged ≥ 75 reached the MCID. Although a significant main effect was observed for the Falls Efficacy Scale-International(MD = -2.80, P = 0.03), the result was not robust. The evidence regarding the effect of TOT on fall incidence or Functional Gait Assessment scores was inconclusive. CONCLUSION: TOT showed superior effects over conventional training in improving balance, gait, and balance confidence, with clinically meaningful improvements in balance and gait speed. However, its impact on reducing fear of falling and fall incidence requires further validation.