Does Perturbation Training Prevent Falls after Discharge from Stroke Rehabilitation? A Prospective Cohort Study with Historical Control

Abstract

Background: Individuals with stroke fall frequently, and no exercise intervention has been shown to prevent falls post stroke. Perturbation-based balance training (PBT), which involves practicing reactions to instability, shows promise for preventing falls in older adults and individuals with Parkinson's disease. This study aimed to determine if PBT during inpatient stroke rehabilitation can prevent falls after discharge into the community.

Methods: Individuals with subacute stroke completed PBT as part of routine inpatient rehabilitation (n = 31). Participants reported falls experienced in daily life for up to 6 months post discharge. Fall rates were compared to a matched historical control group (HIS) who did not complete PBT during inpatient rehabilitation.

Results: Five of 31 PBT participants, compared to 15 of 31 HIS participants, reported at least 1 fall. PBT participants reported 10 falls (.84 falls per person per year) whereas HIS participants reported 31 falls (2.0 falls per person per year). When controlled for follow-up duration and motor impairment, fall rates were lower in the PBT group than the HIS group (rate ratio: .36 [.15, .79]; P = .016).

Conclusions: These findings suggest that PBT is promising for reducing falls post stroke. While this was not a randomized controlled trial, this study may provide sufficient evidence for implementing PBT in stroke rehabilitation practice.

Keywords: Stroke; accidental falls; postural balance; rehabilitation.

Figure 1. Participant flowchart

Participants in the historical cohort were excluded due to insufficient English language ability (n=11), cognitive impairment (n=4), living too far from the hospital (n=2), and not discharged home (n=17); participants in the prospective cohort were excluded as they did not do PBT (n=6), had cognitive impairment (n=1), or were not discharged home (n=2). Twenty-nine participants were recruited from the prospective cohort, and added to 5 historical cohort participants who completed PBT to form the PBT group. Of these, 3 withdrew without completing any falls monitoring, leaving 31 PBT participants for inclusion in the final analysis. From the 73 historical cohort participants who did not complete PBT, 31 were randomly selected to be matched to the PBT participants using the procedure described in the text.