Highlights
- •Reactive balance training improved dynamic stability and trunk control following trips.
- •These led to reduced trip-induced falls in people with multiple sclerosis.
- •Some patients did not tolerate the intervention due to increased pain.
- •The training protocol should be optimised for better efficiency and feasibility.
- •Further research is needed to assess long term effects and improve tolerability.
Abstract
Background
This study examined the feasibility and efficacy of reactive balance training for
improving stepping performance and reducing laboratory-induced falls in people with
multiple sclerosis (MS).
Methods
Thirty people diagnosed with MS (18-70 years) participated in a blinded randomized
controlled trial (ACTRN12618001436268). The intervention group (n = 14) underwent
two 50-minute sessions (total 100 minutes) that exposed them to a total of 24 trips
and 24 slips in mixed order, over one week. The control group (n = 16) received sham
training (stepping over foam obstacles) with equivalent dosage. The primary outcome
was falls into the harness (defined as >30% body weight) when exposed to trips and
slips that were unpredictable in timing, location and type at post-assessment. Physical
and psychological measures were also assessed at baseline and post assessments.
Results
The intervention and control groups completed 86% and 95% of the training protocols
respectively. Incidence rate ratios (95% confidence intervals) of the intervention
group relative to the control group were 0.57 (0.25, 1.26) for all falls, 0.80 (0.30,
2.11) for slip falls and 0.20 (0.04, 0.96) for trip falls in the laboratory. Kinematic
analyses indicated the intervention participants improved dynamic stability, with
higher centre of mass position and reduced trunk sway during recovery steps following
a trip, compared to control. There were no significant differences between the intervention
and control participants at post-assessment for other secondary outcome measures.
Conclusions
Reactive balance training improved trip-induced dynamic stability, limb support, trunk
control and reduced falls in people with MS. More research is required to optimise
the training protocol and determine whether the beneficial effects of reactive balance
training can be retained long term and generalize to fewer daily-life falls.
Keywords
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Article info
Publication history
Accepted:
March 4,
2023
Received in revised form:
February 26,
2023
Received:
November 15,
2022
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2023 Elsevier B.V. All rights reserved.
