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

Objectives To investigate the short- and long-term effects of a task- and context-specific balance training program on dynamic balance and functional performance, and to explore the effects on preventing total and injurious falls in parkinsonian nonfallers. Design A randomized controlled trial with group allocation single-blinded to the assessor. Setting Community centers, malls, and outdoor parks. Participants Nonfallers with Parkinson disease (PD) (N=70; mean age ± SD, 61.2±8.8y) randomly assigned to either a balance (BAL) group (n=32) or a control (CON) group (n=38). Interventions The BAL group received 4 weeks of indoor and 4 weeks of outdoor balance training (with a 2-h session per week). The CON group received 8 weeks of upper limb training at the same dosage. Both groups were instructed to perform 3 hours of home exercise weekly posttraining. Main Outcome Measures (1) Dynamic balance performance: Mini-Balance Evaluation Systems Test (Mini-BESTest); (2) Functional performance: functional reach (FR), 5 times sit-to-stand (FTSTS), 1-leg-stance (OLS), Timed Up and Go (TUG), and dual-task TUG tests; (3) Fall-related outcomes: ratios of total nonfallers to fallers and noninjurious fallers to injurious fallers, total and injurious fall rates, times to first falls and injurious falls. Results Sixty-eight participants completed training. A total of 7 patients (10%) withdrew before the 6-month follow-up, but not because of any adverse effects. At immediate and 6 months posttraining, the BAL group showed significantly greater improvements (from baseline) than the CON group in Mini-BESTest total scores, FR distances, and OLS times, together with greater time reductions in FTSTS, TUG, and dual-task TUG tests (all P<.05). The number of injurious fallers was significantly lower in the BAL group at 6-month follow-up. Conclusions This task- and context-specific balance training program improved the dynamic balance and fall-prone functional performance of PD nonfallers for up to 6 months after training. The BAL group showed a reduction in injurious fallers.