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A. Correia1,2, C. Pimenta1,2, M. Alves3, D. Virella3
1Centro Hospitalar Universitário Lisboa Central, Physiotherapy, Lisboa, Portugal, 2Escola Superior de Tecnologia da Saúde de Lisboa. Instituto Politécnico de Lisboa, Teaching and Research Unit of Physiotherapy and Rehabilitation, Lisboa, Portugal, 3Centro Hospitalar Universitário Lisboa Central, Epidemiology and Statistics Office of the Research Unit, Lisboa, Portugal
Background: Motor control deficits after stroke are associated with a decrease in recovery potential and falls episodes. Gaze stability and oculomotor exercises through vestibulo-ocular reflex helps to coordinate the movements of the head, trunk and pelvis during walking improving balance.
Purpose: To assess the effect of a domiciliary program of oculomotor and gaze stability exercises on the incidence of falls and on the risk of fall after stroke.
Methods: Patients with stroke diagnosis, older than 60 years, discharged from hospital and refereed to the physiotherapy, were recruited to a randomized controlled trial. Patients with stroke 3-15 months earlier, positive Romberg test and the ability to walk independently for more than 3 meters were invited to participated. All individuals who accepted to participate were allocated (block randomization by age, balance and functionality) into the current rehabilitation program (control group - CG) 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 secondary outcomes (clinical significant changes were considered: minimum difference of 4 seconds in TUG and 4 points in BBS). The per protocol analysis assessed the primary outcome by estimation of risk ratios for positive outcomes with 95% confidence intervals. Logistic regression models were used to explore factors that affect the success of the intervention.
Results: 79 patients were recruited (from 248 referred) and 68 completed the protocol (CG 35; IG 33), aged 60-87 years old (median 73), similarly distributed by age, gender, type of stroke and reported falls before recruitment. During the intervention period no falls were registered in the IG and 4 patients fell in the CG. In 11/35 (31.4%) CG patients and in 28/33 (84.8%) IG patients (RR 0.37; 95%CI 0.22–0.62; P < 0.001) clinical significant changes were obtained in BBS and TUG. All the female participants in the IG but just 50% in the CG reached the combined secondary outcome. The best fitted multiple logistic regression model, identified the intervention, female gender and previous Motor Assessment Scale as significantly affecting the odds for the success of the secondary outcome.
Conclusion(s): The estimated risk of falling significantly decreased after three weeks of a domiciliary program of oculomotor and gaze stability exercises; no falls occurred in the IG. These findings encourage further exploration of this promising approach.
Implications: Due the high incidence of falls after stroke and their social and economic impact, the oculomotor and gaze stability exercises can be an efficient complement in the physiotherapy intervention to improve balance and reduce the risk for falls, restoring confidence and empowerment.
Funding, acknowledgements: No external funding was granted to this study.
Keywords: Risk for falls, Stroke, Clinical trial
Topic: Neurology: stroke
Did this work require ethics approval? Yes
Institution: Centro Hospitalar Universitário Lisboa Central
Committee: Centro Hospitalar Universitário Lisboa Central Ethics Committee
Ethics number: 140-2012
All authors, affiliations and abstracts have been published as submitted.
