Association of Lower-Limb Asymmetry with Falls, Physical Performance and Frailty in Older Adults: A Systematic Review

Background/Objectives: Whether lower-limb interlimb asymmetry is associated with adverse outcomes in older adults independently of bilateral strength, power or muscle mass remains unclear. This review synthesized evidence linking lower-limb asymmetry with falls, physical performance and frailty in adults aged ≥ 60 years from populations not defined by a unilateral neurological or musculoskeletal condition.

Methods

Following PRISMA 2020, PubMed, Scopus, Web of Science and EBSCOhost were searched on 2 August 2026 for observational studies quantifying lower-limb asymmetry. Risk of bias was assessed with the Newcastle-Ottawa Scale and AXIS. Because exposure definitions and effect measures were incompatible, meta-analysis was not feasible; a narrative synthesis based on the direction of effect was conducted according to SWiM, and certainty of evidence was rated with GRADE.