A Randomized Controlled Trial of an Enhanced Balance Training Program to Improve Mobility and Reduce Falls in Elderly Patients

Objective: To determine the cost-effectiveness of the HiBalance training program for managing Parkinson’s disease (PD)-related balance and gait disorders. Design: Cost comparison design following the randomized controlled trial comparing a novel balance training intervention with care as usual. Subjects: A total of 100 participants with mild–moderate PD were randomized to either the intervention ( n = 51) or the control group ( n = 49). Intervention: A 10-week (three times per week), group-based, progressive balance training program, led by two physical therapists. Main outcomes: All program costs were collected for both groups. Cost-utility was evaluated using quality-adjusted life years (QALYs) and cost-effectiveness measures were the Mini Balance Evaluation Systems Test (Mini-BESTest; assessing balance performance) and gait velocity. Incremental cost-effectiveness ratios were calculated and a probabilistic sensitivity analysis was conducted. Results: The between-group difference in QALYs was 0.043 (95% confidence interval (CI): 0.011–0.075), favoring the intervention group. Between-group differences in balance performance and gait velocity were 2.16 points (95% CI: 1.19–3.13) and 8.2 cm/second (95% CI: 2.9–13.6), respectively, favoring the intervention group. The mean cost per participant in the intervention group was 16,222 SEK (€1649) compared to 2696 SEK (€274) for controls. The estimated incremental cost-effectiveness ratios were 314,558 SEK (€31,969) for an additional QALY, 6262 SEK (€631) for one point improvement in balance performance, and 1650 SEK (€166) for 1 cm/second increase in gait velocity. Sensitivity analyses indicated a high probability (85%) of program success. Conclusion: In terms of QALYs, the HiBalance program demonstrated a high probability of cost-effectiveness in the short-term perspective when considering the willingness-to-pay thresholds used in Europe.

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Task- and Context-Specific Balance Training Program Enhances Dynamic Balance and Functional Performance in Parkinsonian Nonfallers: A Randomized Controlled Trial With Six-Month Follow-Up

Archives of Physical Medicine and Rehabilitation ◽

10.1016/j.apmr.2015.08.409 ◽

2015 ◽

Vol 96 (12) ◽

pp. 2103-2111 ◽

Cited By ~ 14

Author(s):

Irene S. Wong-Yu ◽

Margaret K. Mak

Keyword(s):

Randomized Controlled Trial ◽

Training Program ◽

Functional Performance ◽

Dynamic Balance ◽

Controlled Trial ◽

Balance Training ◽

Randomized Controlled ◽

Context Specific

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(2) EFFECTIVENESS OF A PROPRIOCEPTIVE BALANCE TRAINING PROGRAM IN HEALTHY ADOLESCENTS: A CLUSTER RANDOMIZED CONTROLLED TRIAL

Clinical Journal of Sport Medicine ◽

10.1097/00042752-200411000-00017 ◽

2004 ◽

Vol 14 (6) ◽

pp. 375 ◽

Cited By ~ 1

Author(s):

C. A. Emery ◽

J. D. Cassidy ◽

T. P. Klassen ◽

R. J. Rosychuk ◽

B. H. Rowe

Keyword(s):

Randomized Controlled Trial ◽

Training Program ◽

Controlled Trial ◽

Balance Training ◽

Cluster Randomized Controlled Trial ◽

Randomized Controlled ◽

Cluster Randomized

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Cross-education effect of balance training program in patients with chronic ankle instability: A randomized controlled trial

Injury ◽

10.1016/j.injury.2020.09.065 ◽

2020 ◽

Author(s):

Nadia Magdy Elsotohy ◽

Yassmin Essam Salim ◽

Nagui Sobhi Nassif ◽

Abeer Farag Hanafy

Keyword(s):

Randomized Controlled Trial ◽

Training Program ◽

Ankle Instability ◽

Controlled Trial ◽

Balance Training ◽

Chronic Ankle Instability ◽

Randomized Controlled ◽

Education Effect ◽

Cross Education

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Effect of a Perturbation-Based Balance Training Program on Compensatory Stepping and Grasping Reactions in Older Adults: A Randomized Controlled Trial

Physical Therapy ◽

10.2522/ptj.20090070 ◽

2010 ◽

Vol 90 (4) ◽

pp. 476-491 ◽

Cited By ~ 134

Author(s):

Avril Mansfield ◽

Amy L. Peters ◽

Barbara A. Liu ◽

Brian E. Maki

Keyword(s):

Older Adults ◽

Randomized Controlled Trial ◽

Training Program ◽

Controlled Trial ◽

Balance Training ◽

Control Program ◽

Community Dwelling ◽

Motion Platform ◽

Randomized Controlled ◽

Compensatory Stepping

BackgroundCompensatory stepping and grasping reactions are prevalent responses to sudden loss of balance and play a critical role in preventing falls. The ability to execute these reactions effectively is impaired in older adults.ObjectiveThe purpose of this study was to evaluate a perturbation-based balance training program designed to target specific age-related impairments in compensatory stepping and grasping balance recovery reactions.DesignThis was a double-blind randomized controlled trial.SettingThe study was conducted at research laboratories in a large urban hospital.ParticipantsThirty community-dwelling older adults (aged 64–80 years) with a recent history of falls or self-reported instability participated in the study.InterventionParticipants were randomly assigned to receive either a 6-week perturbation-based (motion platform) balance training program or a 6-week control program involving flexibility and relaxation training.MeasurementsFeatures of balance reactions targeted by the perturbation-based program were: (1) multi-step reactions, (2) extra lateral steps following anteroposterior perturbations, (3) foot collisions following lateral perturbations, and (4) time to complete grasping reactions. The reactions were evoked during testing by highly unpredictable surface translation and cable pull perturbations, both of which differed from the perturbations used during training.ResultsCompared with the control program, the perturbation-based training led to greater reductions in frequency of multi-step reactions and foot collisions that were statistically significant for surface translations but not cable pulls. The perturbation group also showed significantly greater reduction in handrail contact time compared with the control group for cable pulls and a possible trend in this direction for surface translations.LimitationsFurther work is needed to determine whether a maintenance program is needed to retain the training benefits and to assess whether these benefits reduce fall risk in daily life.ConclusionPerturbation-based training shows promise as an effective intervention to improve the ability of older adults to prevent themselves from falling when they lose their balance.

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