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Results from a randomized controlled trial to address balance deficits after traumatic brain injury (TBI)
Tefertiller C, Hays K, Natale A, O'Dell D, Ketchum J, Sevigny M, Eagye CB, Philippus A, Harrison-Felix C
Archives of Physical Medicine and Rehabilitation 2019 Aug;100(8):1409-1416
clinical trial
5/10 [Eligibility criteria: Yes; Random allocation: Yes; Concealed allocation: No; Baseline comparability: No; Blind subjects: No; Blind therapists: No; Blind assessors: Yes; Adequate follow-up: Yes; Intention-to-treat analysis: No; Between-group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed*

OBJECTIVE: To evaluate the efficacy of an in-home 12-week PT intervention that utilized a virtual reality (VR) gaming system to improve balance in individuals with traumatic brain injury (TBI). SETTING: Home-based exercise program (HEP). PARTICIPANTS: Sixty-three individuals (traditional HEP N = 32; VR N = 31) at least 1 year post-TBI, ambulating independently within the home, not currently receiving physical therapy services. MAIN OUTCOME MEASURES: Primary: Community Balance and Mobility Scale (CB and M); Secondary: Balance Evaluation Systems Test (BESTest), Activities-Specific Balance Confidence Scale (ABC), Participation Assessment with Recombined Tools-Objective (PART-O). RESULTS: No significant between group differences were observed in the CB and M over the study duration (p = 0.9983) for individuals who received VR compared to those who received a HEP to address balance deficits after chronic TBI nor in any of the secondary outcomes: BESTest (p = 0.8822); ABC (p = 0.4343) and Part-O (p = 0.8822). However, both groups demonstrated significant improvements in CB and M and BESTest from baseline to 6, 12, and at 12 weeks follow-up (all p's < 0.001). Regardless of treatment group, 52% of participants met or exceeded the minimal detectable change (MDC) of 8 points on the CB and M at 24 weeks and 38% met or exceeded the MDC of 7.81 points on the BESTest. CONCLUSION: This study did not find that VR training was more beneficial than a traditional HEP for improving balance. However, individuals with chronic TBI in both treatment groups demonstrated improvements in balance in response to these interventions which were completed independently in the home environment.

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