Backward-chaining

Original Editor - Lauren Lopez Top Contributors - Lauren Lopez, Carina Therese Magtibay, Lucinda hampton, Kim Jackson, Rachael Lowe and Shreya Pavaskar

Introduction

Each year, at least one-third of community-dwelling people aged 65 and older worldwide experience a fall. Fall recovery strategies help mitigate the subsequent negative effects of "long lies" (spending 1 hr or more on the floor) after a fall.

Backward-chaining is an intervention used to help older adults learn how to rise safely and independently from the floor. This approach breaks down the task of standing up into smaller, manageable steps. It is practiced in reverse order—starting from the final standing position and working backward to the floor. Through gradual progression in a controlled environment, it builds confidence and reduces fear of falling.

Sequence of steps

The below video visually displays the technique

Step-by-step instruction:

1. Take a step or two forwards then turn steadily around to face the chair. The feet should be hit width apart for stability.
2. Take a stride forward with the strongest leg.
3. Take the upper body forwards and grasp the chair firmly with both hands
4. Transfer the body weight forward so the arms are supporting more of the weight and take a moment to make sure the legs are in a comfortable position and readjust them as needed
5. Lower the back leg carefully down onto the knee
6. Unhook the toes of the back leg for comfort
7. Take the other knee to the floor with control and unhook the toes
8. Walk the knees back so there is space to place the hands down on the floor.
9. From this all fours position lower the hips gently to the preferred side.
10. Rest for a second or two in side sit position with a long back and the hands on the floor close to the body.
11. Push up back onto your knees.
12. Once back on all fours, crawl towards the chair
13. Take a firm grip of the chair seat with both hands and place the foot of the strongest leg as flat as possible on the floor.
14. In one dynamic movement, use the arms and legs to push up onto both feet finishing in a shallow squat position with the weight evenly distributed over both feet.
15. Keep the knees bent while transferring the hands from the chair onto the thighs then use the legs to push up fully into standing

Evidence

In a systematic review involving 446 participants, backward-chaining method improved the ability of older adults to get up unassisted from the floor, leading to increased mobility and decreased number of subsequent falls —particularly following hip fractures.

Although backward-chaining has shown benefits in falls prevention, it is not yet widely adopted in clinical practice. Due to variability in study quality and limited research, further studies are needed to develop standardised procedures to support wider clinical use.