Comparison of Body Weight Support-Assisted Balance and Gait Training With or Without Balance Perturbations in Poststroke Rehabilitation: Multisite Randomized Controlled Trial.

The study was conducted in an inpatient setting where participants were also receiving standard multidisciplinary therapy, so improvements may reflect natural recovery or standard care rather than the specific intervention. The Berg Balance Scale may have had ceiling effects, limiting the ability to detect differences in patients with higher baseline function. Some participants completed only the minimum two sessions due to short lengths of stay, which may have been an insufficient dose to show effects. Clinicians and participants were not blinded to the treatment assignment, which could introduce bias. There was variability in treatment strategies across the four sites, including one site using a high-intensity gait training program not used elsewhere.

The work was funded internally by the participating sites. Two authors (KR and AM) are secondarily employed by Aretech LLC, the manufacturer of the device used in the study. The study design and analysis had no input from the manufacturer.

Do not conclude that balance perturbation training is ineffective in general. This study only tested a specific low-dose protocol (eight perturbations per session) in an inpatient setting alongside standard care. The null result may reflect insufficient dose or the sensitivity of the outcome measures rather than the lack of efficacy of perturbation training itself.