Category: Spinal Cord Injury; Clinical Practice (assessment, diagnosis, treatment, knowledge translation/EBP, implementation science, program development)
Objective: To determine if, and to what extent, fear of falling (FOF) and balance confidence in people with incomplete spinal cord injuries (iSCI) are influenced by perturbation-based balance training (PBT) versus conventional intensive balance training (CIBT).
Design: Mixed methods randomized clinical trial.
Setting: Tertiary SCI rehabilitation hospital.
Participants: Twenty consenting participants with chronic iSCI were recruited from a convenience sample. Eligibility criteria included standing unsupported for 30 seconds and an absence of cardiorespiratory or musculoskeletal comorbidities. Participants were allocated by stratified blocked randomization into groups based on age and injury severity.
Interventions: Participants completed 24 one-hour sessions of PBT or CIBT over eight weeks. Both intervention arms involved individualized balance training, but the PBT group also experienced approximately 50 manual perturbations (i.e. pushes, pulls) throughout each session.
Main Outcome Measure(s): The Falls Efficacy Scale - International (FES-I) and Activities-specific Balance Confidence (ABC) Scale were completed at before, mid-way, and after the program. A two-way mixed ANOVA tested time, group, and group-by-time interaction effects. Three months after finishing the program participants completed a semi-structured interview regarding the impact of the programs on daily life, FOF, and balance confidence.
Results: Both groups improved FES-I (p<0.01) and ABC Scale (p<0.01) scores with training; however improvements were small, with only 15% and 35% of participants achieving clinically relevant changes on the FES-I and ABC Scale, respectively. There were no significant group or interaction effects. Seventeen participants completed the semi-structured interviews to date; 71% perceived decreased FOF and 100% perceived increased balance confidence.
Conclusions: Balance training resulted in meaningful improvements in FOF and balance confidence according to the participants, with no group differences, but this change was not reflected to the same degree by the quantitative scores.
Janelle Unger– PhD Candidate, University of Toronto, Toronto, Ontario
Hardeep Singh– PhD Candidate, University of Toronto, Toronto, Ontario
Avril Mansfield– Scientist, University Health Network, Toronto, Ontario
Beverley Catharine Craven– Senior Scientist/Associate Professor, Dept of Medicine Unversity Health Network, University of Toronto, Toronto, Ontario
Kei Masani– Senior Scientist, Toronto Rehabilitation Institute - University Health Network, Toronto, Ontario
Kristin Musselman– Scientist/Assistant Professor, KITE, Toronto Rehabilitation Institute-University Health Network; Dept. of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, Ontario
Katherine Chan– Research Analyst, University Health Network - Toronto Rehabilitation Institute, Toronto, Ontario