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A randomized controlled trial of an enhanced balance training program to improve mobility and reduce falls in elderly
Jayne Steadman1, Nora Donaldson, Lalit Kalra
1Department of Physiotherapy, Orpington Hospital, Bromley Hospitals NHS Trust, Orpington, United Kingdom.
Objectives:
To evaluate the effectiveness of an enhanced balance training program in improving mobility and well-being of elderly people with balance problems.
Design:
Prospective, single-blind, randomized, controlled trial.
Setting:
District general hospital.
Participants:
One hundred ninety-nine patients aged 60 and older with a Berg Balance Scale (BBS) score of less than 45.
Interventions:
Six weeks enhanced balance training consisting of a series of repetitive tasks of increasing difficulty specific to functional balance. The control group received physiotherapy conforming to existing practice in elderly patients with mobility problems.
Measurements:
Ten-meter timed walk test (TWT), BBS, Frenchay Activities Index (FAI), Falls Handicap Inventory (FHI), and European Quality of Life questionnaire (Euroqol) measured at 6, 12, and 24 weeks after intervention.
Results:
The mean age +/- standard deviation of subjects was 82.7 +/- 5.6, and baseline characteristics were comparable between the groups. Both groups showed improvements in TWT (intervention: 22.5-16.5 seconds, P =.001; control: 20.5-15.8 seconds, P =.054), BBS (intervention: 33.3-42.7, P =.001; control: 33.4-42.0, P <.0001), FAI (18-21, P =.02 in both groups), FHI score (intervention: 31-17, P =.0001; control: 33-17, P =.0001) and Euroqol score (intervention: 58-65, P =.04; control: 60-65, P =.07). There were no intergroup differences at any time. More patients reported increased confidence in walking indoors (36% vs 28%; P =.04) and outdoors (27% vs 18%; P =.02) in the enhanced balance-training group.
Conclusion:
Exercise programs significantly improve balance and mobility in patients with balance problems, independent of strategy. Enhanced balance training may, in addition, improve confidence and quality of life but needs further investigation.