Does attentional focus during balance training in people with Parkinson's disease affect outcome? A randomised controlled clinical trial

Abstract

Objective: To compare the effects of attentional focus to augment balance outcomes in individuals with Parkinson's disease.

Design: Randomised controlled clinical trial.

Setting: University gait and balance research laboratory.

Participants: Forty-nine individuals with idiopathic Parkinson's disease.

Interventions: Participants were randomly assigned into one of four groups (three balance intervention groups and one control). The three intervention groups all received the same 4-week balance training program augmented with either external, internal, or no focus instructions. The control group did not receive any balance training.

Main measures: Outcomes were measured at baseline, post intervention, 2-weeks post intervention, and 8-weeks post intervention and included: Sensory Organization Test, Berg Balance Scale, Self-Selected Gait Velocity, Dynamic Gait Index, Activities-Specific Balance Confidence Scale, and obstacle course completion time.

Results: There were no differences among the groups in trajectory over the course of the trial for all outcomes (ps ⩾ .135). All groups improved from baseline to post intervention and from baseline to 2-weeks post intervention for all outcomes (ps ⩽ .003), except Self-Selected Gait Velocity, which did not change over the course of the trial (P = .121).

Conclusions: Attentional focus instructions to augment a 4-week balance training program did not result in any change over and above a control group in measures of gait and balance in individuals with Parkinson's disease. Additionally, while all four groups improved, there was no difference among the groups, including the control, suggesting that the 4-week balance training program in this trial was not effective.

Keywords: Parkinson disease; attentional focus; balance; motor learning; postural instability.