title: Clinical implementation of a reactive balance control assessment in a sub-acute stroke patient population using a 'lean-and-release' methodology.
abstract: Reactive balance control, specifically performance of rapid stepping responses, is associated with falls, but not routinely assessed in clinical practice. Challenges to clinical assessment may include a lack of available methods that are safe, standardized and able to quantify the balance responses. We implemented a reactive balance control assessment, using lean-and-release methodology, in an inpatient stroke rehabilitation program. Through retrospective chart review of all admissions (n=183) over a 1-year period, we evaluated the clinical uptake and patient-specific factors associated with its use. Seventy-seven of 183 (42%) patients were administered the assessment, on average, 16.2 (SD 13.1) days post-admission. Patients who received the assessment were younger, at an earlier time post-stroke, with a shorter rehabilitation length of stay, with less lower-limb impairment, higher levels of functional balance, less motor and cognitive impairment, greater recovery of functional mobility, and were more likely to have the capacity to walk (all measures p<0.0001), compared to those who did not receive the assessment. This study demonstrates the potential for clinical uptake of the lean-and-release assessment among patients with stroke, who are progressing in their functional and mobility status over the course of their inpatient rehabilitation. However, the results suggest limitations in application to patients with greater disability or who demonstrate slower recovery of functional mobility. Ongoing research is required to develop clinical approaches to reactive balance control assessment that are effective, efficient and relevant to clinical populations and feasible for clinical practice.
authors.affiliation: Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada; Department of Physical Therapy, University of Toronto, Toronto, ON, Canada; Graduate Department of Rehabilitation Science, University of Toronto, Toronto, ON, Canada. Electronic address: liz.inness@uhn.ca.
authors.forename: Elizabeth L
authors.initials: EL
authors.lastname: Inness
authors.affiliation: Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada; Department of Physical Therapy, University of Toronto, Toronto, ON, Canada; Graduate Department of Rehabilitation Science, University of Toronto, Toronto, ON, Canada; Heart & Stroke Foundation, Canadian Partnership for Stroke Recovery, Ottawa, ON, Canada.
authors.forename: Avril
authors.initials: A
authors.lastname: Mansfield
authors.affiliation: Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada; Department of Physical Therapy, University of Toronto, Toronto, ON, Canada.
authors.forename: Louis
authors.initials: L
authors.lastname: Biasin
authors.affiliation: Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada; Department of Physical Therapy, University of Toronto, Toronto, ON, Canada.
authors.forename: Karen
authors.initials: K
authors.lastname: Brunton
authors.affiliation: Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada; Institute of Medical Science, University of Toronto, Toronto, ON, Canada; Heart & Stroke Foundation, Canadian Partnership for Stroke Recovery, Ottawa, ON, Canada.
authors.forename: Mark
authors.initials: M
authors.lastname: Bayley
authors.affiliation: Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada; Department of Physical Therapy, University of Toronto, Toronto, ON, Canada; Graduate Department of Rehabilitation Science, University of Toronto, Toronto, ON, Canada; Heart & Stroke Foundation, Canadian Partnership for Stroke Recovery, Ottawa, ON, Canada; Department of Kinesiology, University of Waterloo, Waterloo, ON, Canada.
authors.forename: William E
authors.initials: WE
authors.lastname: McIlroy
mesh_terms: D000368:Aged; D005260:Female; D020233:Gait Disorders, Neurologic / Q000209:etiology / Q000503:physiopathology* / Q000534:rehabilitation*; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D051346:Mobility Limitation; D026741:Physical Therapy Modalities; D004856:Postural Balance / Q000502:physiology*; D020127:Recovery of Function; D012189:Retrospective Studies; D020521:Stroke / Q000150:complications / Q000503:physiopathology*; D000071939:Stroke Rehabilitation; D016138:Walking / Q000502:physiology
keywords: Outcome assessment; Postural balance; Stroke