Does perturbation-based balance training prevent falls among individuals with chronic stroke? A randomised controlled trial

BMJ Open - Tập 8 Số 8 - Trang e021510 - 2018
Avril Mansfield1,2,3,4,5,6, Anthony Aqui4,5, Cynthia J. Danells1,4,5,6, Svetlana Knorr4,5, Andrew Centen2,3, Vincent DePaul7,8, Alison Schinkel-Ivy9,10, Dina Brooks1,4,5,6, Elizabeth L. Inness1,4,5,6, George Mochizuki1,2,3,4,5,6
1Department of Physical Therapy
2Evaluative Clinical Sciences, Hurvitz Brain Sciences Research Program
3Sunnybrook Research Institute
4Toronto Rehabilitation Institute
5University Health Network
6University of Toronto
7Queen's University
8School of Rehabilitation Therapy
9Nipissing University
10Schulich School of Education – School of Physical and Health Education

Tóm tắt

ObjectivesNo intervention has been shown to prevent falls poststroke. We aimed to determine if perturbation-based balance training (PBT) can reduce falls in daily life among individuals with chronic stroke.DesignAssessor-blinded randomised controlled trial.SettingTwo academic hospitals in an urban area.InterventionsParticipants were allocated using stratified blocked randomisation to either ‘traditional’ balance training (control) or PBT. PBT focused on improving responses to instability, whereas traditional balance training focused on maintaining stability during functional tasks. Training sessions were 1 hour twice/week for 6 weeks. Participants were also invited to complete 2 ‘booster’ training sessions during the follow-up.ParticipantsEighty-eight participants with chronic stroke (>6 months poststroke) were recruited and randomly allocated one of the two interventions. Five participants withdrew; 42 (control) and 41 (PBT group) were included in the analysis.Primary and secondary outcome measuresThe primary outcome was rate of falls in the 12 months post-training. Negative binomial regression was used to compare fall rates between groups. Secondary outcomes were measures of balance, mobility, balance confidence, physical activity and social integration.ResultsPBT participants reported 53 falls (1.45 falls/person-year) and control participants reported 64 falls (1.72 falls/person-year; rate ratio: 0.85(0.42 to 1.69); p=0.63). Per-protocol analysis included 32 PBT and 34 control participants who completed at least 10/12 initial training sessions and 1 booster session. Within this subset, PBT participants reported 32 falls (1.07 falls/person-year) and control participants reported 57 falls (1.75 falls/person-year; rate ratio: 0.62(0.29 to 1.30); p=0.20). PBT participants had greater improvement in reactive balance control than the control group, and these improvements were sustained 12 months post-training. There were no intervention-related serious adverse effects.ConclusionsThe results are inconclusive. PBT may help to prevent falls in daily life poststroke, but ongoing training may be required to maintain the benefits.Trial registration numberISRCTN05434601; Results.

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BMJ Open

Tập 8 Số 8

e021510

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