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Task- and context-specific balance training programme enhances dynamic balance and functional performance in Parkinsonian non-fallers: a randomised controlled trial with six-month follow-up [with consumer summary]
Wong-Yu ISK, Mak MKY
Archives of Physical Medicine and Rehabilitation 2015 Dec;96(12):2103-2111
clinical trial
8/10 [Eligibility criteria: Yes; Random allocation: Yes; Concealed allocation: Yes; Baseline comparability: Yes; Blind subjects: No; Blind therapists: No; Blind assessors: Yes; Adequate follow-up: Yes; Intention-to-treat analysis: Yes; 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 investigate the short- and long-term effects of a task- and context-specific balance training programme on dynamic balance and functional performance, and to explore the effects on preventing total and injurious falls in Parkinsonian (PD) non-fallers. DESIGN: A randomised controlled trial with group allocation single-blinded to the assessor. SETTING: Community centres, malls and outdoor parks. PARTICIPANTS: Seventy PD non-fallers (age 61.2 +/- 8.8 years), randomised into either BAL (n = 32) or CON (n = 38) group. INTERVENTIONS: BAL group received four weeks indoor and four weeks outdoor balance training (with a two-hour session/week). CON group received eight weeks of upper limb training at the same dosage. Both groups were instructed to perform 3 hours home exercise weekly post-training. OUTCOME MEASURES ASSESSED: (1) Dynamic balance performance: Mini-BESTest; (2) functional performance: functional reach (FR), five-time-sit-to-stand (FTSTS), one-leg-stance (OLS), time-up-and-go (TUG) and dual-task TUG tests; (3) fall-related outcomes: ratios of total non-fallers to fallers and non-injurious fallers to injurious fallers, total and injurious fall rates, times to first falls and injurious falls. RESULTS: Sixty-eight participants completed training. A total of seven patients (10%) withdrew before the six-month follow-up, but not due to any adverse effects. At immediate and six-month post-training, BAL group showed significantly greater improvements (from baseline) than CON group in Mini-BESTest total scores, FR distances and OLS times, together with greater time reductions in FTSTS, TUG and dual-task TUG tests (all p < 0.05). The number of injurious fallers was significantly lower in BAL group at six-month follow-up. CONCLUSION: This task- and context-specific balance training programme improved the dynamic balance and fall-prone functional performance of PD non-fallers for up to six months after training. The BAL group showed a reduction in injurious fallers.

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