Clinician-Led Balance Training in Pulmonary Rehabilitation

Introduction: Guidelines for pulmonary rehabilitation (PR) include balance training but specific parameters are lacking. Following studies on the effects of balance training and a knowledge translation project at our centre, modifications were made by clinicians to facilitate the sustainability of balance training as part of PR. The purpose of this study was to explore if the modified program resulted in improved balance and balance confidence. A secondary aim was to provide information on the way in which balance training was operationalized as part of PR for clinicians looking to incorporate balance training into existing PR programs. Methods: We conducted a retrospective study. Patients with COPD enrolled in inpatient PR over a one-year period were included. Balance training was provided bi-weekly with a staff-to-patient ratio of 2:11. Balance (the primary outcome) was assessed using the brief balance evaluation systems test (brief-BESTest), and balance confidence (the secondary outcome) was assessed using the activities-specific balance confidence (ABC) scale. Results: Of the 85 participants, 45 (52.9%) were men and the total sample had a mean age of 69.5 (SD 9.0) years. Participants completed an average of 7.6 balance sessions (min-max 2-13) over approximately 6 weeks. They had improvements in balance (brief-BESTest within-group mean difference 3.2 (95% CI 2.5 to 3.9) points) and balance confidence (ABC within-group mean difference 7.8 (95% CI 4.1 to 11.5) percent). Conclusion: A staff-to-patient ratio of 2:11 and a training frequency of twice per week for 4-6 weeks improved balance. This will inform the incorporation of balance training into existing PR programs.