The effect of brief, repetitive balance training on balance and fall risk in older people with stroke: A randomized controlled trial

Abstract

Objective: To evaluate the effect of integrating a specific balance-training program focused on static balance to the conventional rehabilitation program on dynamic balance, risk of falls, and activities of daily living (ADLs) in older adults post-stroke. Design: A single-blinded randomized controlled trial. Setting: Institutional Intermediate Care Hospital. Subjects: Post-stroke older adults in a subacute phase without cognitive impairment, aged 65 years and older, exhibiting trunk control in a seated position for 30 seconds without supporting the arms. Intervention: The control group underwent the usual treatment, consisting of 60-minute physiotherapy sessions, 5 days per week, for 30 days. The experimental group integrated into the usual treatment 15 minutes of the balance-training program (45 min + 15 min). Main measures: Balance impairment (Mini-BESTest and Berg Balance Scale (BBS), risk of falls (BBS), and independence for ADLs (Barthel Index)) were assessed at baseline, 15 and 30 days after the start of interventions. Results: Seventy-one post-stroke patients (77.7 ± 9.0 years, 49.2% women) were randomized into the experimental (n = 35) or control (n = 36) groups. The experimental group showed improved dynamic balance at day 15 (Mini-BESTest: 2.90 [1.05–4.77], p = 0.003; BBS: 4.31 [1.41–7.23], p = 0.004) and day 30 (Mini-BESTest: 6.06 [2.85–9.27], p < 0.001; BBS: 8.24 [2.96–13.53], p = 0.003), as well as greater independence levels (11 [2.75–19.23], p = 0.010) compared to the control group. The control group showed higher risk of falls on day 15 (p = 0.035) and day 30 (p = 0.003) than the experimental group. Conclusions: A simple, easily reproducible approach designed by and for the older adult to rehabilitate post-stroke impairments effectively improved balance, functional gait, risk of falls, and ADLs.