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Training on Biodex balance system improves balance and mobility in the elderly.

Byline: Furqan Ahmed Siddiqi and Tahir Masood


Objectives: To determine the effects of balance training with visual feedback using static and dynamic Biodex balance system for fall risk and mobility.

Methods: The two-arm pilot randomised controlled trial was conducted from July to October 2016 at Fauji Foundation Hospital Rawalpindi and comprised community-dwelling elderly individuals. Subjects having no major co-morbid conditions were recruited via non-probability purposive sampling. Subjects were randomly divided in two equal groups. The intervention group received 8-week training on Biodex balance system and the control group received no intervention. Data was collected using Biodex fall risk score, Berg balance scale and Timed Up and Go Test before and after the treatment. Data was analysed using SPSS 20.

Results: There were 18 subjects in two groups of 9(50%) each. Analysis within the groups showed significant improvement in the intervention group (p0.05) was observed in the control group. Post-intervention the result remained unchanged while comparing the two groups (p0.05) justified use of parametric tests. Analysis between groups was done using independent samples t-test whereas analysis within the groups was done using paired samples t-test. Level of significance was set at p<0.05.

Table-1: Demographics distribution between BDEX Group and CTRL Group.

Variable###CTRL Group###BDEX Group





Gender Distribution



Table-2: Between Group analysis after 8-week assessment for BBS, BFRS and TUG.

Variable###BDEX Group###CTRL Group###P Value




Table-3: Within Group analysis for BBS, BFRS and TUG.

Variable###Group###Baseline Assessment###8 Week Assessment###P Value

BBS###BDEX Group###40.89+-1.76###45.22+-1.30###<0.001

###CTRL Group###42.78+-5.87###41.89+-4.73###0.67

BFRS###BDEX Group###5.29+-0.75###3.18+-0.64###<0.001

###CTRL Group###4.03+-1.39###4.19+-1.44###0.82

TUG###BDEX Group###15.45+-1.50###11.07+-0.85###<0.001

###CTRL Group###16.12+-3.37###16.48+-3.36###0.42


There were 18 subjects in two groups of 9(50%) each. The overall mean age was 62.89+-7.91 years. Mean height and weight was 1.59+-0.09 meters and 74.48+-10.68 kg respectively, whereas mean BMI was 29.48+-3.86 kg/m 2. There were 7(38.9 %) males and 11(61.1%) females (Table1). No significant difference was observed between the groups after 8 weeks of intervention (p=0.07) (Table-2). Analysis within the groups showed significant improvement (p=0.52) after 8 weeks was observed in the CTRL Group (Table-3). Similar to BBS, no significant difference (p=0.08) was seen in BFRS between the groups post-intervention. Analysis within the groups showed significant improvement in BDEX group (p<0.001) whereas the CTRL group showed no significant improvement (p=0.82) after 8 weeks.

In contrast to BBS and BFRS, TUG showed significant difference between the groups (p<0.001). Analysis within groups showed significant improvement in BDEX group (p<0.001) whereas the CTRL group showed no significant improvement (p=0.42) after 8 weeks (Table-3).


There is a recognised need for objective measurement indices for balance/risk of fall, yet limited evidence on such measures is available. Moreover, no commercially available device has emerged as gold standard of balance assessment. 21 The BDEX has a wide range of clinical applications for balance training and evaluation. It has proved its worth as a consistent and objective apparatus. 22 Many previous studies have reported about this system to improve body balance and avert falls among the elderly through neuromuscular training. 23 This study is first of its kind in Pakistan to assess and train the elderly population using modern balance training and assessment system obtaining quantitative and objective balance measures. The result of this study were promising and showed that over period of 8 weeks, there was significant improvement in balance and mobility of subjects in BDEX Group compared to CTRL Group, showing noticeable reduction in fall-risk.

Although there was statistically no significant difference between groups in BBS and BFRS, analysis within groups in BBS and BFRS showed that there was marked difference between baseline and post-intervention values in BDEX group, showing striking reduction in fallrisk as shown by improvement in BBS and BFRS compared to the CTRL group; hence proving improvement of balance was more in BDEX group compared to CTRL group. Similarly, significant improvement occurred in mobility of BDEX group compared to CTRL group as shown by decreasing TUG scores. The findings of the current study are similar to another research on balance improvement using Biodex system which demonstrated a considerable improvement in Biodex fall-risk index after discharge from rehabilitation (p<0.001). In contrast, a study had some limitations as no control group was recruited and fewer trainers were available for BDEX use.24

In another study on balance improvement in diabetic patients using BDEX, TUG test (p = 0.01), fall risk index (FRI) (p=0.002) and BBS (p=0.04) showed considerable improvement in the treatment group after training, but had no distinct changes in the CTRL Group. 15 These findings are in line with the findings of the current study where significant improvement over time was observed in BBS, TUG and BFRS of BDEX Group. The findings of the current study support the result of another study in which balance training using the BDEX SD was done by the BDEX Group. The TUG test, Romberg test, BBS, FRI and postural stability tests were assessed in both groups at baseline and after 12 weeks. There was significant improvement in the outcome measures of TUG, FRI, and overall stability index (OSI) in the treatment group after 24 sessions. 17 A randomised control trial on institutionalised older people for balance training involved 12-week protocol comprised of balance/re-balance training (two sessions per week) with BDEX.

There was greater reduction in fall risk in intervention group at 12 weeks compared to the control group. 23 These results are also supported by our study which showed significant improvement in mobility, static and dynamic balance and reducing fall risk as indicated by BBS, TUG, Biodex fall risk scores. The current study was a pilot study conducted in a single centre. The sample was limited and not pre-calculated. Thus, the results of the study cannot be generalised to general population. Further multi-centre studies need to be carried out with larger sample sizes to make the results more generalisable.


Dynamic postural balance training using BDEX SD had a positive effect on mobility and balance in healthy older individuals and can be used as a training tool to reduce fall risk and improve balance and mobility.

Acknowledgments: We are grateful to Dr. Muhammad Ehab Azim P.T. and Dr. Sana Khalid P.T. for their help in proof-reading the draft. Thanks are also due to Foundation University, Islamabad, for providing necessary equipment and work space.

Disclaimer: This article is part of a Ph.D. Rehabilitation Sciences dissertation.

Conflict of Interest: None.

Source of Funding: None


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Publication:Journal of Pakistan Medical Association
Geographic Code:9PAKI
Date:Nov 30, 2018
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