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J Neurol Phys Ther. 2016 Jan;40(1):24-30. doi: 10.1097/NPT.0000000000000111.

Highly Challenging Balance Program Reduces Fall Rate in Parkinson Disease.

Author information

1
VA Boston Healthcare System and Department of Medicine (D.S.), Boston University School of Medicine, Boston, Massachusetts; Center for Neurorehabilitation (T.R.D., K.H., T.E.), Department of Physical Therapy and Athletic Training, College of Health and Rehabilitation Sciences: Sargent, Boston University, Boston, Massachusetts; and Department of Neurology (C.A.T., M.S.H.), Boston University Medical Campus, Boston University, Boston, Massachusetts.

Abstract

BACKGROUND AND PURPOSE:

There is a paucity of effective treatment options to reduce falls in Parkinson disease (PD). Although a variety of rehabilitative approaches have been shown to improve balance, evidence of a reduction in falls has been mixed. Prior balance trials suggest that programs with highly challenging exercises had superior outcomes. We investigated the effects of a theory-driven, progressive, highly challenging group exercise program on fall rate, balance, and fear of falling.

METHODS:

Twenty-three subjects with PD participated in this randomized cross-over trial. Subjects were randomly allocated to 3 months of active balance exercises or usual care followed by the reverse. During the active condition, subjects participated in a progressive, highly challenging group exercise program twice weekly for 90 minutes. Outcomes included a change in fall rate over the 3-month active period and differences in balance (Mini-Balance Evaluation Systems Test [Mini-BESTest]), and fear of falling (Falls Efficacy Scale-International [FES-I]) between active and usual care conditions.

RESULTS:

The effect of time on falls was significant (regression coefficient = -0.015 per day, P < 0.001). The estimated rate ratio comparing incidence rates at time points 1 month apart was 0.632 (95% confidence interval, 0.524-0.763). Thus, there was an estimated 37% decline in fall rate per month (95% confidence interval, 24%-48%). Improvements were also observed on the Mini-BESTest (P = 0.037) and FES-I (P = 0.059).

DISCUSSION AND CONCLUSIONS:

The results of this study show that a theory-based, highly challenging, and progressive exercise program was effective in reducing falls, improving balance, and reducing fear of falling in PD.Video abstract available for more insights from the authors (see Supplemental Digital Content 1, http://links.lww.com/JNPT/A120).

TRIAL REGISTRATION:

ClinicalTrials.gov NCT02302144.

PMID:
26655100
PMCID:
PMC4681297
DOI:
10.1097/NPT.0000000000000111
[Indexed for MEDLINE]
Free PMC Article

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