title: Does attentional focus during balance training in people with Parkinson's disease affect outcome? A randomised controlled clinical trial.
abstract: OBJECTIVE
  To compare the effects of attentional focus to augment balance outcomes in individuals with Parkinson's disease.
  
  
  METHODS
  Randomised controlled clinical trial.
  
  
  METHODS
  University gait and balance research laboratory.
  
  
  METHODS
  Forty-nine individuals with idiopathic Parkinson's disease.
  
  
  METHODS
  Participants were randomly assigned into one of four groups (three balance intervention groups and one control). The three intervention groups all received the same 4-week balance training program augmented with either external, internal, or no focus instructions. The control group did not receive any balance training.
  
  
  METHODS
  Outcomes were measured at baseline, post intervention, 2-weeks post intervention, and 8-weeks post intervention and included: Sensory Organization Test, Berg Balance Scale, Self-Selected Gait Velocity, Dynamic Gait Index, Activities-Specific Balance Confidence Scale, and obstacle course completion time.
  
  
  RESULTS
  There were no differences among the groups in trajectory over the course of the trial for all outcomes (ps ⩾ .135). All groups improved from baseline to post intervention and from baseline to 2-weeks post intervention for all outcomes (ps ⩽ .003), except Self-Selected Gait Velocity, which did not change over the course of the trial (P = .121).
  
  
  CONCLUSIONS
  Attentional focus instructions to augment a 4-week balance training program did not result in any change over and above a control group in measures of gait and balance in individuals with Parkinson's disease. Additionally, while all four groups improved, there was no difference among the groups, including the control, suggesting that the 4-week balance training program in this trial was not effective.
authors.affiliation: Department of Physical Therapy, University of Nevada Las Vegas, USA merrill.landers@unlv.edu.
authors.forename: Merrill R
authors.initials: MR
authors.lastname: Landers
authors.affiliation: Department of Physical Therapy, University of Nevada Las Vegas, USA.
authors.forename: Rebecca M
authors.initials: RM
authors.lastname: Hatlevig
authors.affiliation: Department of Physical Therapy, University of Nevada Las Vegas, USA.
authors.forename: Alyssa D
authors.initials: AD
authors.lastname: Davis
authors.affiliation: Department of Physical Therapy, University of Nevada Las Vegas, USA.
authors.forename: Amanda R
authors.initials: AR
authors.lastname: Richards
authors.affiliation: Department of Physical Therapy, University of Nevada Las Vegas, USA.
authors.forename: Leslee E
authors.initials: LE
authors.lastname: Rosenlof
mesh_terms: D000058:Accidental Falls / Q000517:prevention & control; D000368:Aged; D000704:Analysis of Variance; D001288:Attention / Q000502:physiology*; D016001:Confidence Intervals; D005081:Exercise Therapy / Q000379:methods* / Q000523:psychology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D010300:Parkinson Disease / Q000175:diagnosis* / Q000534:rehabilitation*; D004856:Postural Balance / Q000502:physiology*; D011446:Prospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome
keywords: Parkinson disease; attentional focus; balance; motor learning; postural instability