EFFECT OF PERTURBATION-BASED BALANCE TRAINING ON FALL-RELATED OUTCOMES IN INDIVIDUALS WITH PARKINSON'S DISEASE: A RANDOMIZED CONTROLLED TRIAL

Abstract

Background: Impaired postural control, mobility, and concern about falling are important functional problems in individuals with Parkinson’s disease (PD). Perturbation-based balance training (PBT) specifically targets reactive postural responses required to recover from unexpected disturbances. This study evaluated the effect of PBT on fall-related outcomes compared with conventional balance exercise in individuals with PD. Methods: A two-arm, parallel-group randomized controlled trial was conducted among 52 individuals with PD at Hoehn and Yahr stages I–III. Participants were randomly allocated in a 1:1 ratio to a PBT group (n = 26) or conventional balance exercise (CBE) group (n = 26). Both groups received supervised balance training for 8 weeks, three sessions per week, with 24 sessions of 45–60 minutes each. The PBT group received progressive externally induced perturbations combined with reactive stepping, dynamic balance, and functional activities, whereas the CBE group received conventional static, dynamic, and functional balance exercises. The primary outcome was dynamic balance measured using the Mini-BESTest. Secondary outcomes were falls efficacy, functional mobility, and comfortable gait speed, measured using the FES-I, TUG, and gait-speed assessment, respectively. Results: Forty-seven participants completed the study (PBT, n = 23; CBE, n = 24). Both groups improved through all outcomes, with significantly greater improvements in the PBT group. Mini-BESTest scores increased by 3.9 points in the PBT group compared with 1.9 points in the CBE group (group × time interaction: F = 14.86, p < 0.001, partial η² = 0.248). FES-I scores decreased by 5.1 versus 2.7 points (F = 8.74, p = 0.005, partial η² = 0.163), TUG performance improved by 1.82 versus 0.91 seconds (F = 6.82, p = 0.012, partial η² = 0.132), and gait speed increased by 0.11 versus 0.05 m/s (F = 5.41, p = 0.025, partial η² = 0.107) in the PBT and CBE groups, respectively. Conclusion: Eight weeks of PBT produced greater improvements in dynamic balance, falls efficacy, functional mobility, and comfortable gait speed than conventional balance exercise in individuals with mild-to-moderate PD. PBT may therefore be a useful rehabilitation approach for improving fall-related functional outcomes in this population.