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

Abstract

Objectives: No 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.

Design: Assessor-blinded randomised controlled trial.

Setting: Two academic hospitals in an urban area.

Interventions: Participants 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.

Participants: Eighty-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 measures: The 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.

Results: PBT 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.

Conclusions: The 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 number: ISRCTN05434601; Results.

Keywords: accidentaly falls; exercise; physiotherapy; postural balance; rehabilitation medicine; stroke.

Figure 1

Participant flow through the study. Eight participants who consented to participate in the study were excluded on the initial assessment because they could not tolerate the lean-and-release postural perturbations. Participants were withdrawn after randomisation because it became apparent that they did not meet the study criteria (one PBT participant had osteoporosis with history of fracture and one control participant had uncontrolled hypertension), or because they had a significant decline in health during the training portion of the study (one PBT and one control participant). One PBT participant withdrew from the study because she did not like the group allocation. Therefore, there were 42 control participants and 41 PBT participants available for analysis of the primary outcome (falls in daily life). Participants withdrew during the 12-month follow-up period because they: no longer wished to be in the study (two PBT and one control participant); experienced a serious adverse event (two PBT, five control participants); were lost to follow-up (two PBT, three control participants); or enrolled in a conflicting study (two PBT participants). PBT, perturbation-based balance training.