Balance Intervention Research Articles

Closing the gap while standing still: clinimetric properties of a low-cost balance platform and a user-friendly app for posturography

Background The Wii Balance Board (WBB) is used as a rehabilitation tool for balance or strength interventions and posturography in balance tasks. Nonetheless, implementation of posturography using the WBB in a clinical setting is hampered by required technical skills for signal processing to obtain meaningful balance measures. Therefore, this study aims to evaluate the concurrent validity and test–retest reliability of a WBB to measure center of pressure (COP) parameters and to provide an easy-to-use web application to improve implementation of posturography in clinical practice. Methods A cross-sectional study was carried out including 30 healthy adults who performed repeated balance tasks including single and double leg standing still with eyes open or eyes closed. A WBB on top of a laboratory-grade force plate synchronously measured COP. Parameters based on COP displacement were calculated, including standard deviation of displacement, velocity, pathlength and 95% predicted ellipse area. Results The concurrent validity of the WBB to measure COP in quiet standing still tasks was excellent for all parameters (Intraclass Correlation Coefficient (ICC) > 0.900, p < 0.001), apart from medio-lateral velocity (ICC = 0.571, p = 0.090 to ICC = 0.711, p = 0.057). For the single leg balance tasks, across the two measurements, all WBB COP derived parameters showed excellent correlations with COP parameters derived from a laboratory-grade force plate (ICC > 0.95, p < 0.001). Test–retest reliability of the WBB was poor (ICC below 0.5) to occasionally good (ICC between 0.75 to 0.90) for the COP parameters from quiet standing balance tasks. Comparable reliability was found for the repeated measurements of single leg standing still. Power spectra analysis of both force plates revealed larger measurement error by the WBB in medio-lateral direction in tasks requiring minimal postural adjustments. Conclusion The WBB revealed excellent concurrent validity with a laboratory-grade force plate for balance tasks on a single leg or two legs for most COP parameters. The reliability was poor to moderate for most tasks, however comparable to the findings from the laboratory grade force plate. An open-source web application, employing R Shiny, was created to provide a tool to analyse COP parameters. Hereby, it was demonstrated that open-source scientific tools may help researchers to bridge the gap between scientific findings and clinical use of posturography.

Does intervention sequence impact self-regulatory and behavioral outcomes in an adaptive trial among adults with prediabetes?

ABSTRACT Background: Lifestyle interventions can promote improvement in dietary intake and physical activity (PA), on average, by strengthening motivation, self-regulatory efforts, and commitment to behavioral change. However, maintenance of behavioral change is challenging, and slow responders during treatment often experience less overall success. Adaptive intervention sequences tailored to treatment response may be more effective in sustaining behavioral change. Methods: Adults ≥ 21 years old with prediabetes (n = 187) were stratified at week five to the standard Group Lifestyle Balance (GLB) intervention, if they achieved > 2.5% weight loss, or to the augmented intervention GLB Plus (GLB+) at week five, if they did not. At month five, each person in a matched pair was randomly assigned to GLB or GLB + for the extended intervention phase (months 5-12) followed by no study conduct (months 13-18). The primary comparison of interest was the change in outcomes between the standard (GLB followed by GLB) and augmented (GLB + followed by GLB+) intervention sequences post-intervention at 12 – and 18-months using linear mixed effect models. Results: The augmented GLB + intervention sequence reported a decline in the change in self-efficacy for reducing fat intake, self-efficacy for ‘sticking to’ healthy eating and exercise, and hopeful thought and planning compared to the standard GLB intervention sequence (all P < 0.0167) at 18-months. However, there were no significant differences between these intervention sequences at 18-months in the change in dietary intake or minutes of PA (all P > 0.05). Conclusions: No significant change in behavioral measures across intervention sequences occurred at study end. An 18-month decline in self-efficacy regarding diet and PA and hopeful thought and planning among slow responders following no intervention for six months indicates greater extended care is likely needed. The type of extended care that is most effective for slow treatment responders requires additional research.

Serious Game-Based Balance Training with Augmented Kinesthetic Feedback Enhances Aspects of Postural Control in Poststroke Patients: A Randomized Clinical Trial.

Background: Poststroke hemiparesis presents with motor asymmetry and decreased postural control leading to functional limitations. Serious games (SG) for balance rehabilitation of people with stroke may improve motor recovery, and the visual and auditory feedback provided by the SGs helps to explain the therapeutic benefits. However, the contribution of SG combined with kinesthetic and verbal cues during balance training has not been investigated. The aim of this study is to compare the effects of two feedback conditions for an SG balance intervention, with or without the addition of kinesthetic and verbal cues, on balance performance of people with stroke. Methods: Thirty people with chronic poststroke hemiparesis and balance impairment participated in this randomized controlled trial and performed 14 individual SG training sessions combined with kinesthetic and verbal cues provided by the physical therapist or with SG's feedback only. Outcomes were assessed before training (pre), 1 week after the end of training (post), and 8 weeks after the end of training, which were adopted as the follow-up period, using the Balance Evaluation Systems Test, Lower Limb Subscale of Fugl-Meyer, six-minute walk test, and Stroke-Specific Quality of Life Scale. Results: The results showed that SG combined with kinesthetic and verbal cues improved outcomes relating to lower limb function and some balance domains (biomechanical constraints and limits of stability outcomes) better than with SG's feedback only. Both groups had similar significant improvement in quality of life and long-distance walking performance. Conclusion: This study is the first to directly compare two feedback conditions for SG-based balance intervention. The addition of kinesthetic and verbal cues during the SG balance improved aspects of postural control better than without this form of feedback.

Effects of an Instability Training Program Using Global Versus Selective Instability Devices on Dynamic Balance and Ankle Stability in Young Amateur Soccer Players.

Background/Objectives: Both Sides Utilized it is one of the most employed global instability devices (GID), but it is difficult to progress and select a particular foot structure. In this sense, the Blackboard has been created as selective instability device (SID). The aim of this study is to compare the effects of both devices on balance and ankle stability. Methods: The study was designed as a randomized controlled clinical trial. Twenty healthy amateur soccer players were divided into two groups: GID and SID. Both performed balance training (4-weeks, 3 days/week). Ankle balance and stability were assessed. Paired t-tests were used to analyze the pre-, post-, and between-groups differences. Results: No differences were found between the groups. Significant intra-group changes were found in both groups for posterolateral balance and summation. Moreover, posteromedial balance increased in the GID group. No changes were found in ankle stability results. Conclusions: A balance intervention using GID or SID is effective in improving general and posterolateral balance. Moreover, the GID intervention improved posteromedial balance.

The Effect of Towel Toe Curl Exercise and Tibialis Posterior Strengthening on Dynamic Balance of Flatfoot Patients at SD Negeri 104242 Lubuk Pakam

Background: Improper use of the foot can cause problems when walking and even endanger a person's health. The arch of the foot helps withstand impact pressure and provides stability when standing or walking. Flatfoot is a deformity related to the foot, such as medial longitudinal arch disorders of the foot, valgus deformity of the heel, and forefoot abduction. The exercise methods that can be given to overcome flatfoot are Towel toe curl exercise and tibialis posterior strengthening. Purpose: to improve foot function by strengthening the intrinsic muscles of the foot. While tibialis posterior strengthening exercise is to strengthen the tibialis posterior muscle, which is part of the extrinsic muscle. Research method: This type of research is quantitative with a one group pre-test and post-test design. Data analysis using paired sample t-test. The sample of this study were children at SD Negeri 104242 Lubuk Pakam who suffered from flatfoot with a total of 22 samples. The intervention given was towel toe curl and tibialis posterior strengthening 3 times a week for 4 weeks with a total of 12 actions. Before the dynamic balance intervention, respondents were measured first (pretest) with the Y Balance Test (YBT) and re-measured after the intervention (Posttest). Results and discussion: The results of the paired sample t-test obtained a significant value (p) of 0.000, greater than the alpha value (a) (0.000 &lt;0.05), meaning that there is a significant effect of towel toe curl exercises and tibialis posterior strengthening on improving dynamic balance in flatfoot children. Conclusion: Based on the results of the study, it can be concluded that towel toe curl exercises and tibialis posterior strengthening can be one of the training methods that can be applied to overcome dynamic balance disorders in flatfoot sufferers

Investigating postural control as a predictor of low back and pelvic girdle pain during and after pregnancy

BackgroundFalls are common during pregnancy, posing risks to maternal and fetal health. Pregnant individuals also commonly experience low back and/or pelvic girdle pain. Other populations with pain, such as older adults with back pain demonstrate increased fall risk. This study assessed the relationship between standing balance control characteristics during single leg stance and low back/pelvic girdle pain scores during and after pregnancy with eyes open and closed. We hypothesized that standing balance control characteristics of smaller sway and sway velocity would be related to greater low back/pelvic girdle pain during the third trimester. MethodsDuring the second trimester, third trimester, and postpartum nineteen individuals performed single leg stance on a force platform with eyes open and closed and completed the Quebec Back Pain Disability Scale. Stepwise multiple linear regressions were used to investigate the variance of Quebec Back Pain Disability Scale scores that could be explained by postural control variables for each time point and condition. FindingsDuring the third trimester, decreased total sway and anterior/posterior sway range with eyes closed were significantly associated with higher low back/pelvic girdle pain disability scores (P = 0.005, R2 = 0.480). No significant relationships were found during the second trimester or postpartum nor for eyes open conditions. InterpretationThis study suggests a potential association between low back/pelvic girdle pain and postural control during pregnancy. Pregnant individuals with lumbopelvic pain may demonstrate postural stability deficits, particularly without visual input. Balance assessments and interventions should be considered during routine care for pregnant individuals, especially for those with pain.

Balancing the prescription of virtual reality balance training for Parkinson disease: a critically appraised topic

Clinical Scenario Individuals with Parkinson Disease (PD) often present with impaired balance, resulting in increased fall risk. Evidence suggests that balance can be improved with physical therapy balance training interventions applied through video game play, or ‘exergaming’. However, best practices regarding the prescription of exergaming for persons with PD are unknown. The goal of this appraisal was to identify the Nintendo Wii exergame (NWE) parameters that have been shown to improve dynamic balance in individuals with PD, specifically Hoehn and Yahr (HY) stages 1-3, and make recommendations for the prescription of NWE balance interventions for this population. Methods The literature was searched to identify randomized controlled trials (RCT) that utilized NWE as a balance intervention for individuals with PD within HY stages 1-3. The search was limited to articles published within the last 10 years that assessed dynamic balance outcomes via the Dynamic Gait Index (DGI) or Functional Gait Assessment (FGA). Participants had no other known comorbidities that would impact dynamic balance and were on a stable dopaminergic prescription. 3 RCTs were identified and included in this appraisal. Conclusion and Implications for Practice NWE may improve dynamic balance in individuals with PD, HY stages 1-3. Recommended parameters include a variety of NWE modes, performed for 45-50 min per session, at a frequency of 2-3 times a week for 6-8 weeks. Clinicians should utilize a skilled approach when prescribing NWE including ongoing assessment to determine progress and to maintain safety. Future research is needed to determine the necessary intensity of NWE to improve dynamic balance in individuals with PD.

Exploring Responsiveness to Highly Challenging Balance and Gait Training in Parkinson's Disease.

Exercise potentially improves gait, balance, and habitual physical activity in Parkinson's disease (PD). However, given the heterogeneous nature of the disease, it is likely that people respond differently to exercise interventions. Factors determining responsiveness to exercise interventions remain unclear. To address this uncertainty, we explored the responsiveness to our highly challenging balance and gait intervention (HiBalance) in people with PD. Thirty-nine participants with mild-moderate PD who underwent the HiBalance intervention from our randomized controlled trial were included. We defined response in three domains: (1) balance based on Mini-BESTest, (2) gait based on gait velocity, and (3) physical activity based on accelerometry-derived steps per day. In each domain, we explored three responsiveness levels: high, low, or non-responders according to the change from pre- to post-intervention. Separate Random Forests for each responder domain classified these responsiveness levels and identified variable importance. Only the Random Forest for the balance domain classified all responsiveness levels above the chance level indicated by a Cohen's kappa of "slight" agreement. Variable importance differed among the responsiveness levels. Slow gait velocity indicated high responders in the balance domain but showed low probabilities for low and non-responders. For low and non-responders, fall history or no falls, respectively, were more important. Among three responder domains and responsiveness levels, we could moderately classify responders in the balance domain, but not for the gait or physical activity domain. This can guide inclusion criteria for balance-targeted, personalized intervention studies in people with PD.

The Reliability of Field-Based Static and Dynamic Balance Tests in Primary School-Aged Autistic Children.

Previous research has proven that the balance of autistic children is poor. However, the reliability of assessing balance in this cohort has been inadequately researched. This study therefore aimed to examine if field-based static and dynamic balance tests can be reliably assessed in autistic children, to determine the number of familiarisation sessions required and whether autistic severity impacts on the reliability of these balance tests. The balance of eighteen primary school-aged autistic children was assessed three times a week over five weeks, using the flamingo balance test, a modified version of the balance error scoring system (BESS), the low beam walking test, and the heel to toe walking test. Reliability criteria included an intraclass correlation coefficient (ICC) level of ≥0.75 and a coefficient of variance (CV%) of ≤46% for the low beam walking test, the heel to toe walking test, and the BESS, and a CV% of ≤82% or the flamingo balance test. Inter-session reliability was achieved and required the least number of familiarisation sessions for the flamingo balance test, compared to the low beam walking test, which required a greater number of familiarisation sessions to achieve inter-session reliability. The heel to toe walking test and the BESS achieved inter-session reliability and familiarisation in an acceptable time frame. Due to the large CV% values reported in the current study, practitioners need to be aware that balance interventions need to achieve improvements greater than the CV% in this cohort.

Process evaluation protocol plan for a home-based physical activity intervention versus educational intervention for persistent taxane-induced peripheral neuropathy (B-HAPI study): a randomized controlled trial

BackgroundEvaluation publications typically summarize the results of studies to demonstrate the effectiveness of an intervention, but little is shared concerning any changes implemented during the study. We present a process evaluation protocol of a home-based gait, balance, and resistance exercise intervention to ameliorate persistent taxane-induced neuropathy study according to 7 key elements of process evaluation.MethodsThe process evaluation is conducted parallel to the longitudinal, randomized control clinical trial examining the effects of the home-based gait, balance, and resistance exercise program for women with persistent peripheral neuropathy following treatment with taxanes for breast cancer (IRB approval: Pro00040035). The flowcharts clarify how the intervention should be implemented in comparable settings, fidelity procedures help to ensure the participants are comfortable and identify their individual needs, and the process evaluation allows for the individual attention tailoring and focus of the research to avoid protocol deviation.ConclusionsThe publication of the evaluation protocol plan adds transparency to the findings of clinical trials and favors process replication in future studies. The process evaluation enables the team to systematically register information and procedures applied during recruitment and factors that impact the implementation of the intervention, thereby allowing proactive approaches to prevent deviations from the protocol. When tracking an intervention continuously, positive or negative intervention effects are revealed early on in the study, giving valuable insight into inconsistent results. Furthermore, a process evaluation adds a participant-centered element to the research protocols, which allows a patient-centered approach to be applied to data collection.Trial registrationClinicalTrials.gov NCT04621721, November 9, 2020, registered prospectively. Protocol version: April 27, 2020, v2.

Virtual Reality Applications for Balance Rehabilitation and Efficacy in Addressing Other Symptoms in Multiple Sclerosis—A Review

(1) Background: Since multiple sclerosis (MS) is a neurological pathology known for its disabling effects across many domains, the introduction of virtual reality (VR) usage has been attempted, as it represents a new method of approach to rehabilitation and treatment of chronic neurological pathologies. Encouraging research has explored the use of video game consoles and VR-assisted Robot-Assisted Gait Training (RAGT) to address balance disturbances in this population. (2) Methods: The search involved two databases, Web of Science and PubMed, utilizing a selection of terms including “Virtual reality”, “Multiple sclerosis”, “Balance”, and “Rehabilitation”. Two reviewers initiated and performed the search for articles, subsequently selecting and extracting data from the studies. The PEDro scale was the tool for evaluating the quality of the articles that we introduced in our research. (3) Results: After rigorous scanning, nine articles remained eligible for our study. VR interventions, particularly compared to standard balance training, consistently improved balance in multiple sclerosis. Robotic-assisted technology with 2D VR yielded superior results in balance rehabilitation. VR interventions had varied effects on walking speed. They have shown promise in decreasing the risk of falls and improving patients’ daily lives while reducing fatigue in multiple sclerosis. (4) Conclusions: VR offers comparable or superior benefits to classical exercise and no intervention for balance but does not significantly improve functional mobility. However, it shows the potential to improve quality of life and fatigue in MS patients. Investigation of VR alongside RAGT is important to be performed with larger sample sizes and comprehensive results are needed to fully understand its efficacy in MS rehabilitation.

Beyond the Classroom: Insights into Work-Life Balance Experiences of Women Teachers in Patna, Bihar

This paper delves into the work-life balance experiences of women teachers in Patna, Bihar, aiming to provide valuable insights into the challenges they face and potential strategies for improvement. Utilizing a mixed-methods approach, the study examines the perceptions and experiences of female educators regarding workload, support systems, family responsibilities, and organizational policies. Quantitative data, gathered through surveys, and qualitative data, obtained via interviews, are analyzed to offer a comprehensive understanding of the work-life dynamics in this context. The findings highlight the significance of work-life balance policies and interventions in educational institutions to support female teachers' well-being and professional satisfaction. The implications of the study's findings for practice and policy are discussed, along with recommendations for fostering a more supportive work environment that promotes work-life balance among women teachers in Patna, Bihar.

Effect of a Short-Term Combined Balance and Multidirectional Plyometric Training on Postural Balance and Explosive Performance in U-13 Male and Female Soccer Athletes

This study’s aim is to examine the effect of a combined balance and multidirectional plyometric training intervention on postural balance ability and lower limb explosive performance in U-13 male and female soccer athletes. Twenty pre-adolescent (age: 12.6 ± 1.6 years) soccer athletes followed a 6-week training intervention combining balance exercises, dynamic stabilization tasks and multidirectional plyometric exercises at a frequency of twice/week for 20–25 min, based on a progressive increase in exercise difficulty from phase A (week 1–3) to phase B (week 4–6). Pre- and post-training measurements were carried out to assess the following: (a) static balance performance in single (left, right)-legged and two-legged quiet stance trials with eyes open and eyes closed (two trials per stance and vision condition of 30 s duration) and (b) lower limb explosive performance in countermovement and squat jumps without arm swing (three trials/jump). The vertical GRF was recorded by a customized force plate (Wii, 1.000 Hz, Biovision) and offline, CoP and explosive performance parameters were calculated. The overall results showed that the static balance ability of athletes remained unaffected, while restricting their vision deteriorated their postural control. The lower limb explosive performance showed a trend for improvement; however, inter-individual variations in athletes’ responses might have obscured any effect.

Effects of rehabilitation exercise program types on dynamic balance in patients with stroke: a meta-analysis of randomized controlled trials

ABSTRACT Purpose The purposes of meta-analysis are to evaluate evidence about the effects of Rehabilitation Exercise Program on the balance of post-stroke patients, evaluated by the Berg Balance Scale (BBS). Methods The search was conducted ‘stroke,’ ‘rehabilitation,’ ‘dynamic balance,’ ‘Berg Balance Scale,’ ‘exercise’ and ‘randomized controlled trial’using MEDLINE (accessed by PubMed), Web of Science (WoS), ProQuest, and Google Scholar for journal studies published from January 2018 to October 2022. Two independent reviewers performed the article selection, data extraction, and methodological quality assessment. The main outcome was dynamic balance assessed by the Berg Balance scale. Results The review included 30 papers and a total of 540 patients. The overall effect size was 0.550, a medium effect size according to the Cohen’s standard. It was observed that gender has moderate effect size in male (0.551), female (0.458) and higher in male. Exercise type results showed large effect sizes in balance training (0.966), and aquatic activities (0.830), moderate effect sizes in virtual reality (0.762), moderate effect sizes in physically active (0.581), gait training (0.541), dual-task (0.478), trunk control (0.284), and small effect sizes in resistance training (0.128). Conclusions Exercise programs are effective in improving dynamic balance in stroke patients. Especially, the meta-analysis showed higher Effect Size for balance training and virtual reality than for other programs making this relevant interventions for future head to head superiority studies that compare different balance interventions in stroke.

The Effect of Agility Balance and Coordination Warm-Up on Children’s Tennis Performance

Background and Aims: Tennis is also a sophisticated action, intense confrontation, technical and tactical use of complex and varied network antagonistic sport, on physical and mental intelligence aspects of the higher requirements, emphasizing skills and physical dominance. The purpose of this study is to select 40 male children aged 6-10 years old from a tennis club in Xi'an for a group experiment based on the selection conditions of age, height, weight, training time no more than 6 months, and training twice a week, and to find out the theoretical basis of agility, balance, and coordination intervention training on the improvement of children's tennis hitting ability. Materials and Methods: This study adopts the literature method, expert interview method, experiment method, and mathematical statistics method. Five expert professors were interviewed, and the validity of expert interviews and experimental results was measured by IOC, t-test, and other data. Through 8 weeks of agility, balance, and coordination training in the experimental group and the control group, and 90 minutes of intervention training twice a week, it is concluded that the experimental group and the control group have significant differences, and the experimental group has significantly improved its ability in batting and other aspects. Results: The results showed that: (1) 8-week agility, balance, and coordination intervention training applied in the warm-up part significantly improved the agility, balance, and coordination ability of children's tennis in the experimental group, and the intervention program was feasible to improve the agility, balance and coordination ability of children's tennis students in the interest class. (2) After 8 weeks of agility, balance, and coordination training, the number of goals scored by the students in the experimental group in the scoring area of 1, 2, and 3 points of forehand stroke showed a significant difference compared with before training, while the difference was only significant in the scoring area of 1 point of the backhand stroke. It shows that 8 weeks of agility, balance, and coordination training can improve the stability and accuracy of forehand strokes more obviously. Conclusion: (1) Stability and accuracy are based on good agility, balance, and coordination. Agility, balance, and coordination can improve the accuracy and stability of forehand and backhand in tennis training for children. (2) 6-10 years old is the best period for children to conduct agility, balance, and coordination intervention training, so strengthening agility, balance, and coordination training in tennis warm-up training can not only improve the stability and accuracy of children's tennis shots but also increase children's interest and concentration.

Effects of physical exercise interventions on balance, postural stability and general mobility in Parkinson's disease: a network meta-analysis.

To assess which type of physical exercise intervention has the most beneficial effects on balance, postural stability and general mobility in patients with Parkinson's disease. These parameters were assessed using the Activities-specific Balance Confidence (ABC) scale, Berg Balance Scale (BBS), Mini-Balance Evaluation Systems Test (MiniBESTest) and Timed Up and Go Test (TUG). Network meta-analysis. The PubMed, Cochrane Central Register of Controlled Trials, and Web of Science databases were searched up to August 2022 to identify randomized controlled trials on the effects of physical exercise interventions on balance, postural stability, and general mobility. The network meta-analysis included pairwise and indirect comparisons of results on the ABC scale, BBS, MiniBESTest, and TUG across 8 categories of physical exercise. Eighty-six studies with a total of 4,693 patients were included. For the ABC scale, the indirect comparison showed that the highest effect size was observed for balance vs sensorimotor training without including endurance interventions (0.62; 95% confidence interval (95% CI) 0.06, 1.17). The highest effect sizes for BBS were observed for alternative exercises (1.21; 95% CI 0.62, 1.81), body-weight supported (BWS) interventions (1.31; 95% CI 0.57, 2.05), dance (1.18; 95% CI 0.33, 2.03) and sensorimotor training, including endurance interventions (1.10; 95% CI 0.46, 1.75) vs control groups. Indirect comparisons showed that the highest effect size for the MiniBESTest were observed for balance (0.75; 95% CI 0.46, 1.04) and resistance (0.58; 95% CI 0.10, 1.07) vs control groups. For the TUG, comparisons showed a significant effect size for alternative exercises (-0.54; 95% CI -0.82, -0.26), balance (-0.42; 95% CI -0.75, -0.08), resistance (-0.60; 95% CI -0.89, -0.31), and sensorimotor training including endurance interventions (-0.61; 95% CI -0.95, -0.27) vs control comparisons. Balance interventions improve balance, postural stability, and general mobility in people with Parkinson's disease. Moreover, alternative exercises, dance, BWS interventions, resistance, and sensorimotor training, including and not including endurance interventions, are also effective.

Effectiveness of task-specific training for improving balance performance in children with cerebral palsy (CP): a narrative systematic review

IntroductionA body of research has focused on helping children with disabilities stay physically active. As poor balance has been found as a major limitation in physical activities, a systematic review exploring balance intervention programs is warranted.MethodsThe primary aim of this is to systematically evaluate evidence for the effect of task-specific training to improve balance outcomes in ambulant children with cerebral palsy. Seven databases were searched for studies involving ambulant children with cerebral palsy (4–15 years old); balance TST; and balance-related outcomes. The quality of the studies was appraised using the JBI Critical Appraisal Checklists for risk of bias, study design, and quality of evidence. Continuous data were transformed and summarised using standardised mean difference and 95%CI.ResultsSeven randomised controlled trials met the inclusion criteria. The risk of bias was deemed low in most of the studies. Due to heterogeneity of study design and outcome measures, a narrative synthesis was conducted. Positive between-group effects favouring TST were found across the six studies (BBS d = 1.528, 95% CI = 0.7747–2.2813) and follow-up (BBS d = –1.667, 95% CI = –2.459 ÷ –0.874). Despite poor reporting of motor learning strategies, repetitive practice, feedback, and task modulation strategies were used consistently in balance TST.ConclusionsTST could be recommended to be a part of an intervention programme to improve balance performance in children with CP. However, more studies with rigorous study design and adequately powered implementation of a more fun task-oriented training programme are needed.

Quality of fluid balance charting and interventions to improve it: a systematic review

IntroductionFluid balance monitoring is pivotal to patients’ health. Thus, fluid balance charting is an essential part of clinical nursing documentation. This systematic review aimed to investigate and describe the quality...

An Internet- and Kinect-Based Multiple Sclerosis Fitness Intervention Training With Pilates Exercises: Development and Usability Study.

Balance impairments are common in people with multiple sclerosis (MS), with reduced ability to maintain position and delayed responses to postural adjustments. Pilates is a popular alternative method for balance training that may reduce the rapid worsening of symptoms and the increased risk of secondary conditions (eg, depression) that are frequently associated with physical inactivity. In this paper, we aimed to describe the design, development, and usability testing of MS Fitness Intervention Training (MS-FIT), a Kinect-based tool implementing Pilates exercises customized for MS. MS-FIT has been developed using a user-centered design approach (design, prototype, user feedback, and analysis) to gain the target user's perspective. A team composed of 1 physical therapist, 2 game programmers, and 1 game designer developed the first version of MS-FIT that integrated the knowledge and experience of the team with MS literature findings related to Pilates exercises and balance interventions based on exergames. MS-FIT, developed by using the Unity 3D (Unity Technologies) game engine software with Kinect Sensor V2 for Windows, implements exercises for breathing, posture, and balance. Feedback from an Italian panel of experts in MS rehabilitation (neurologists, physiatrists, physical therapists, 1 statistician, and 1 bioengineer) and people with MS was collected to customize the tool for use in MS. The context of MS-FIT is traveling around the world to visit some of the most important cities to learn the aspects of their culture through pictures and stories. At each stay of the travel, the avatar of a Pilates teacher shows the user the exercises to be performed. Overall, 9 people with MS (n=4, 44% women; mean age 42.89, SD 11.97 years; mean disease duration 10.19, SD 9.18 years; Expanded Disability Status Scale score 3.17, SD 0.75) were involved in 3 outpatient user test sessions of 30 minutes; MS-FIT's usability was assessed through an ad hoc questionnaire (maximum value=5; higher the score, higher the usability) evaluating easiness to use, playability, enjoyment, satisfaction, and acceptance. A user-centered design approach was used to develop an accessible and challenging tool for balance training. All people with MS (9/9, 100%) completed the user test sessions and answered the ad hoc questionnaire. The average score on each item ranged from 3.78 (SD 0.67) to 4.33 (SD 1.00), which indicated a high usability level. The feedback and suggestions provided by 64% (9/14) of people with MS and 36% (5/14) of therapists involved in the user test were implemented to refine the first prototype to release MS-FIT 2.0. The participants reported that MS-FIT was a usable tool. It is a promising system for enhancing the motivation and engagement of people with MS in performing exercise with the aim of improving their physical status.

Using the matrixed multiple case study methodology to understand site differences in the outcomes of a Hybrid Type 1 trial of a peer-led healthy lifestyle intervention for people with serious mental illness.

Site differences in implementation trial outcomes are common but often not examined. In a Hybrid Type 1 trial examining the effectiveness-implementation of a peer-led group life-style balance (PGLB) intervention for people with serious mental illness (SMI) in three supportive housing agencies, we found that PGLB recipients' physical health outcomes differed by study sites. The matrixed multiple case study methodology was used to explore how implementation outcomes and changes in context of usual care (UC) services contributed to these site differences. Two implementation outcomes (i.e. PGLB fidelity ratings and intervention recipients' acceptability of PGLB and UC) and changes in healthcare services integration at the study sites were examined. ANOVAs were used to examine site differences in fidelity ratings and client satisfaction. Directed content analysis was used to analyze leadership interviews to identify changes in the context of UC services. Site 3 showed a trend approaching significance (P = .05) towards higher fidelity ratings. High levels of satisfaction with PGLB were reported at all sites. Significant differences in PGLB recipients' satisfaction with UC were found, with Site 3 reporting the lowest levels of satisfaction. Agency leaders reported an increase in prioritizing client's health throughout the trial with sites differing in how these priorities were put into action. Differences in PGLB recipients' satisfaction with UC, and changes in healthcare service integration seemed to have contributed to the site differences in our trial. The matrixed multiple case study methodology is a useful approach to identify implementation outcomes contributing to the heterogeneity of multisite implementation trial results.