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Authors
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Abstract(s)
Abstract
Title: Domiciliary gaze stability and oculomotor exercises improves balance after stroke.
BetterBalance, a randomized controlled trial
Authors: Anabela Correia1,2, Carla Pimenta1,2, Marta Alves3, Daniel Virella3
1. Physiotherapy Department, Hospital Curry Cabral, Centro Hospitalar Universitário Lisboa
Central, Portugal.
2. Department of Rehabilitation Science and Technology, Escola Superior de Tecnologia da Saúde
de Lisboa, Instituto Politécnico de Lisboa,
3. Epidemiology and Statistics Office of the Research Unit, Centro Hospitalar Universitário Lisboa
Central, Portugal.
Background: Visual stabilization and the vestibulo-ocular reflex as mechanisms of gaze stability
are needed to coordinate the movements of the head, trunk and pelvis during walking. Balance
impairment after stroke is strongly associated with more severely impaired motor function, a
decrease in recovery potential and an increase of the number of falls.
Purpose: To verify the efficacy of a domiciliary training program for balance impairment after stroke
in senior patients.
Methods: Patients older than 60 years, discharged after stroke to the physiotherapy department,
were recruited to a randomized controlled trial for improving orthostatic balance (ClinicalTrials.gov:
NCT02280980). Eligible patients had stroke 3-15 months earlier, positive Romberg test and
autonomous walk for ³3m. Participants were allocated (block randomization by age, balance and
functionality) into the current rehabilitation program (observational group - OG) or into a
supplemental intervention focused on a domiciliary program of oculomotor and gaze stability
exercises (intervention group - IG) for three weeks. Primary outcome was the incidence of falls; the
variation of the estimated risk for falls by Berg Balance Scale (BBS) and Timed Up and Go Test
(TUG) were surrogate outcomes: minimum difference of 4 seconds in TUG and 4 points in BBS.
Data were analyzed by per protocol. Relative Risk (RR) for the outcome was estimated with 95%
confidence interval (95%CI). Multivariable logistic regression was applied to model for the decrease
of the risk for falls. Results: From the 217 referred patients, 71 were recruited and completed the protocol 61 patients
(OG 32; IG 29), aged 60-87 years old (median OG 73; IG 74), similarly distributed by gender, type
of stroke and reported falls before recruitment (OG 21/32; IG 15/29). No falls were registered in the
IG and 4 patients fell in the OG. The surrogate outcome occurred in 11/32 OG patients and in 26/29
IG patients (RR 2.61; 95%CI 1.59 - 4.28; p<0.001); all the IG females reached the surrogate
outcome. The increase of BBS was larger (p<0.001) in the IG (median difference 7 vs. 2); a weak
evidence of difference on TUG was observed (median difference OG=-0.72 sec. and IG=-1.28 sec.;
p=0.059). The model for decrease of the estimated risk for falls revealed that the intervention lead
to a 21.4 fold increase on the odds (aOR 21.43; 95%CI 4.75 – 96.66; p<0.001) and that females had
4.75 fold higher odds for decrease than males (aOR 4.75; 95%CI 1.11 – 20.25; p=0.035).
Conclusions: The trial did not reach power to assess the efficacy of the intervention as actually
preventing falls, although evidence was obtained that complementary oculomotor and gaze stability
exercises decrease the estimated risk for falls and that this decrease is larger in females.
Implications: Domiciliary oculomotor and gaze stability exercises are a promising approach as a
complement in the physiotherapy intervention after stroke, whenever balance impairment is present.
Given the high incidence of falls in these patients and their social and economic impact, this can be
an efficient strategy to improve balance and reduce the risk for falls.
Keywords: risk for falls, stroke, clinical trial
Funding acknowledgements: No external funding was granted to this study.
Brief biography of presenting author: Anabela Correia (presenting author) is a Portuguese
Physiotherapist, with a graduation from the Escola Superior de Tecnologia da Saúde de Lisboa
(ESTESL) and a MSc degree Physiotherapy from ESTESL.
Works as a physiotherapist as part of a multidisciplinary team in a Rehabilitation Department in a
central hospital in Lisbon (Hospital Curry Cabral, Centro Hospitalar Universitário Lisboa Central) for
more than 20 years and as an invited assistant, teaching at ESTESL since 2012. The mainly interest
and current work is focus in vestibular and balance disorders in patients with vestibular, neurologic
pathology and in patients with a high risk of falls.
Information concerning any presentations or publications of the work made prior to congress
This trial is registered (ClinicalTrials.gov NCT02280980) and the study protocol was published
[Pimenta C, Correia A, Alves M, Virella D (2017) Effects of oculomotor and gaze stability exercises
on balance after stroke: Clinical trial protocol. Porto Biomedical Journal. 2(3):76–80]. In this
presentation will be released the preliminary results.
Description
Keywords
CHLC MFR CHLC CINV Stroke Oculomotor Muscles Falls
Citation
IN: World Confederation for Physical Therapy; 2019, 10 a 13 Mai. Geneva, Switzerland
Publisher
Serviço de Medicina Física e Reabilitação e Centro de Investigação do Centro Hospitalar Universitário de Lisboa Central, EPE