Optimal reactive balance training characteristics post-stroke: secondary analysis of a randomized controlled trial

Background and purposeReactive balance training (RBT) has shown promise for enhancing reactive balance control and reducing falls post-stroke. However, the optimal training parameters (e.g., intensity, duration) are unknown. This study aimed to investigate the relationship between different reactive balance training characteristics and improvements in reactive balance control and fall rates. MethodsPeople with chronic stroke completed up to 12 one-hour reactive balance training sessions, twice per week. Training included experiencing losses of balance due to internal or external perturbations while performing voluntary tasks. The tasks were of four types: stable, quasi-mobile, mobile, and unpredictable, each with choice of three difficulty levels (normal, increased, or reduced). We analyzed the relationships between training characteristics (total number of perturbations, difficulty levels, perceived level challenge, and success rate) and fall rates post-training and changes in the reactive balance control sub-score of the mini-Balance Evaluation Systems Test (mini-BESTest). ResultsA higher number of perturbations was significantly associated with better post-intervention reactive balance scores on the mini-BEST (p=0.010). There were no significant associations with any other training characteristics and post-intervention mini-BEST Scores. For falls in daily life there was no significant association between any training characteristic. DiscussionGreater exposure to RBT was associated with improvements in reactive balance control among individuals with chronic stroke. Participants who completed more sessions, and consequently experienced more perturbations, achieved better outcomes. These findings highlight the importance of sufficient training volume, suggesting that a higher number of perturbations may be optimizing the effects of RBT in stroke rehabilitation. Trial registrationISRCTN05434601