Mansfield Avril, Schinkel-Ivy Alison, Danells Cynthia J, Aqui Anthony, Aryan Raabeae, Biasin Louis, DePaul Vincent G, Inness Elizabeth L
Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada; Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada; Sunnybrook Research Institute, Toronto, Ontario, Canada.
Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada; School of Physical and Health Education, Nipissing University, North Bay, Ontario, Canada.
J Stroke Cerebrovasc Dis. 2017 Oct;26(10):2174-2180. doi: 10.1016/j.jstrokecerebrovasdis.2017.04.041. Epub 2017 Jun 1.
Individuals with stroke fall frequently, and no exercise intervention has been shown to prevent falls post stroke. Perturbation-based balance training (PBT), which involves practicing reactions to instability, shows promise for preventing falls in older adults and individuals with Parkinson's disease. This study aimed to determine if PBT during inpatient stroke rehabilitation can prevent falls after discharge into the community.
Individuals with subacute stroke completed PBT as part of routine inpatient rehabilitation (n = 31). Participants reported falls experienced in daily life for up to 6 months post discharge. Fall rates were compared to a matched historical control group (HIS) who did not complete PBT during inpatient rehabilitation.
Five of 31 PBT participants, compared to 15 of 31 HIS participants, reported at least 1 fall. PBT participants reported 10 falls (.84 falls per person per year) whereas HIS participants reported 31 falls (2.0 falls per person per year). When controlled for follow-up duration and motor impairment, fall rates were lower in the PBT group than the HIS group (rate ratio: .36 [.15, .79]; P = .016).
These findings suggest that PBT is promising for reducing falls post stroke. While this was not a randomized controlled trial, this study may provide sufficient evidence for implementing PBT in stroke rehabilitation practice.
中风患者经常跌倒，且尚无运动干预措施被证明可预防中风后跌倒。基于扰动的平衡训练（PBT），即练习对不稳定情况的反应，在预防老年人和帕金森病患者跌倒方面显示出前景。本研究旨在确定住院中风康复期间的PBT能否预防出院后进入社区的跌倒。
亚急性中风患者作为常规住院康复的一部分完成了PBT（n = 31）。参与者报告了出院后长达6个月的日常生活中经历的跌倒情况。将跌倒发生率与住院康复期间未完成PBT的匹配历史对照组（HIS）进行比较。
31名PBT参与者中有5人报告至少跌倒1次，而31名HIS参与者中有15人报告至少跌倒1次。PBT参与者报告了10次跌倒（每人每年0.84次跌倒），而HIS参与者报告了31次跌倒（每人每年2.0次跌倒）。在控制随访时间和运动障碍后，PBT组的跌倒发生率低于HIS组（率比：0.36 [0.15, 0.79]；P = 0.016）。
这些发现表明PBT在减少中风后跌倒方面有前景。虽然这不是一项随机对照试验，但本研究可能为在中风康复实践中实施PBT提供充分证据。
