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The effect of perturbation-based balance training and conventional intensive balance training on reactive stepping ability in individuals with incomplete spinal cord injury or disease: a randomized clinical trial
Unger J, Chan K, Lee JW, Craven BC, Mansfield A, Alavinia M, Masani K, Musselman KE
Frontiers in Neurology 2021 Feb 2;12(620367):Epub
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*

INTRODUCTION: Impaired balance leads to falls in individuals with motor incomplete spinal cord injury or disease (iSCI/D). Reactive stepping is a strategy used to prevent falls and perturbation-based balance training (PBT) can improve this ability. OBJECTIVE(S): The objective of this study was to determine if PBT results in greater improvements in reactive stepping ability than frequency-matched conventional intensive balance training (CIBT) in adults with iSCI/D. DESIGN(S): Randomized clinical trial. SETTING(S): Tertiary SCI/D rehabilitation center. PARTICIPANT(S): Twenty-one adults with chronic (> 1 year) iSCI/D were randomized. Due to one drop out 20 participants completed the study. METHOD(S): Participants were randomly allocated to complete either PBT or CIBT three times per week for 8 weeks. Both programs included challenging static and dynamic balance tasks, but the PBT group also experienced manual external balance perturbations. MAIN OUTCOME MEASURE(S): Assessments of reactive stepping ability using the Lean-and-Release test were completed at baseline, and after 4 and 8 weeks of training, and 3 and 6 months after training completion. A blinded assessor evaluated secondary outcomes. RESULT(S): Twenty-five participants were screened and 21 consented; one withdrew. Ten PBT and 10 CIBT participants were included in analyses. Across all participants there were improvements in reactive stepping ability (p = 0.049), with retention of improvements at follow up assessments. There were no differences in reactive stepping ability between groups (median (interquartile range) PBT 0.08 (0.68); CIBT 0.00 (0.22)). One participant in the PBT group experienced a non-injurious fall during training. CONCLUSION(S): Balance training is beneficial for individuals with iSCI/D, but the addition of manual perturbations (ie, PBT) did not prove advantageous for performance on a measure of reactive stepping ability. CLINICAL TRIAL REGISTRATION: www.ClinicalTrials.gov identifier NCT02960178.

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