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Background/Purpose
Chronic obstructive pulmonary disease (COPD) is a respiratory disease that results in pro- gressive airflow limitation and respiratory distress. Physiopathological features of COPD suggest that people who suffer from this disease have many risk factors for falls that have been identified in older individuals. The aim of the study...
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Background/Purpose: Chronic obstructive pulmonary disease (COPD) is a respiratory disease that results in progressive airflow limitation and respiratory distress. Physiopathological features of COPD suggest that people who suffer from this disease have many risk factors for falls that have been identified in older individuals. The aim of the study...
Objective
This study aimed to investigate the serum inflammatory cytokines levels in patients with COPD, pneumonia and lung cancer, and assess the correlation between the levels of inflammatory cytokines levels and development of these diseases.
Methods
Two hundred thirty-two patients including 114 patients with pneumonia, 76 patients with chronic...
Introduction
Patients with chronic obstructive pulmonary disease (COPD) may demonstrate cognitive function and balance deterioration. These two phenomena are often realized simultaneously during daily living activities, where the risk of falling may be increased due to possible postural disturbance when focusing on a cognitive task during motion. D...
Citations
... In COPD, a 10 cm·s −1 reduction in gait speed increased the risk for hospital readmission (OR 1.43, 95% CI 1.13 to 1.80, per 10 cm·s −1 reduction) [69]. Yet, further research is needed to assess the effect of the identified gait speed reduction on other relevant COPD outcomes, including falls [5,[70][71][72][73]. Interestingly, the identified mean usual gait speed for people with COPD corresponds exactly with the gait speed threshold that is considered a marker of increased fall risk (i.e. 100 cm·s −1 ) [74,75]. ...
Background: Despite the importance of gait as a determinant of falls, disability and mortality in older people, understanding of gait impairment in COPD is limited. This study aimed to identify differences in gait characteristics during supervised walking tests between people with COPD and healthy controls.
Methods: We searched 11 electronic databases, supplemented by Google Scholar searches and manual collation of references, in November 2019 and updated the search in July 2021. Record screening and information extraction were performed independently by one reviewer and checked for accuracy by a second. Meta-analyses were performed in studies not considered at a high risk of bias.
Results: Searches yielded 21 085 unique records, of which 25 were included in the systematic review (including 1015 people with COPD and 2229 healthy controls). Gait speed was assessed in 17 studies (usual speed: 12; fast speed: three; both speeds: two), step length in nine, step duration in seven, cadence in six, and step width in five. Five studies were considered at a high risk of bias. Low-quality evidence indicated that people with COPD walk more slowly than healthy controls at their usual speed (mean difference (MD) −19 cm·s −1 , 95% CI −28 to −11 cm·s −1) and at a fast speed (MD −30 cm·s −1 , 95% CI −47 to −13 cm·s −1). Alterations in other gait characteristics were not statistically significant.
Conclusion: Low-quality evidence shows that people with COPD walk more slowly than healthy controls, which could contribute to an increased falls risk. The evidence for alterations in spatial and temporal components of gait was inconclusive.
... The reliability domain through test-retest was evaluated in seven studies with adequate and sufficient measures 22,27,28,31,32 . The measurement error was reported in only two studies and with insufficient data for an adequate classification 22,31 . ...
... The reliability domain through test-retest was evaluated in seven studies with adequate and sufficient measures 22,27,28,31,32 . The measurement error was reported in only two studies and with insufficient data for an adequate classification 22,31 . ...
Objectives to identify balance assessment instruments, issues and risks of issues used in COPD, evaluate their measurement properties, quality of evidence and clinical utility. Method A review was produced following the PRISMA and COSMIN guidelines, registered in PROSPERO: CRD42021235118. Searches were carried out from November 2021 to September 2022 in the PubMed, LILACS, CINAHL, Embase, Web of Science and PEDro databases. Cross-sectional and cohort observational studies were included, without restrictions on language or year of publication, as long as they described clinical instruments for assessing balance, falls and risk of falls reporting at least one of the measurement properties: validity, reliability and responsiveness. Two reviewers will independently apply the eligibility criteria, travel risk by COSMIN, quality of evidence by the GRADE approach and assessment of clinical utility by the Tyson and Connell Scale. Results 9,102 studies were selected and 21 included in the review, nine studies demonstrated adequate and sufficient measurement properties and 12 instruments were identified, of which six were evaluated for the quality of evidence. Conclusion Systematic reviews of measurement properties require specialized reviewers and skills in qualitative analysis. With a recommendation GRADE of “A”, the Berg Balance Scale (BBS) and the Timed Up and Go (TUG) test were the most recommended instruments for COPD. By requiring the evaluation of the clinical utility of the result, the TUG demonstrates superiority to the BBS, proving to be a great tool for judging individuals who need a thorough assessment of balance, falls and risk of falls.
... O domínio confiabilidade através do teste-reteste foi avaliado em sete estudos com medidas adequadas e suficientes 22,27,28,31,32 . O erro de medida foi relatado em apenas dois estudos e com dados insuficientes para uma adequada classificação 22,31 . ...
... O domínio confiabilidade através do teste-reteste foi avaliado em sete estudos com medidas adequadas e suficientes 22,27,28,31,32 . O erro de medida foi relatado em apenas dois estudos e com dados insuficientes para uma adequada classificação 22,31 . ...
Resumo Objetivos Identificar os instrumentos de avaliação de equilíbrio, quedas e risco de quedas utilizados na DPOC, avaliar suas propriedades de medida, qualidade da evidência e utilidade clínica. Método A revisão foi produzida seguindo as orientações PRISMA e COSMIN, registrada no PROSPERO: CRD42021235118. As pesquisas foram realizadas de novembro de 2021 a setembro de 2022 nas bases de dados PubMed, LILACS, CINAHL, Embase, Web of Science e PEDro. Estudos observacionais transversais e coorte foram incluídos, sem restrição de idioma ou ano de publicação, desde que descreveram instrumentos clínicos de avaliação do equilíbrio, quedas e risco de quedas reportando no mínimo, uma das propriedades de medida: validade, confiabilidade e responsividade. Dois revisores independentemente aplicaram os critérios de elegibilidade, risco de viés pela COSMIN, qualidade da evidência pela abordagem GRADE e a avaliação da utilidade clínica pela Escala de Tyson e Connell. Resultados 9.102 estudos foram selecionados e 21 incluídos na revisão, nove estudos demonstraram propriedades de medida adequadas e suficientes e 12 instrumentos foram identificados, dos quais seis, foram avaliados quanto a qualidade de evidência. Conclusão Revisões sistemáticas de propriedades de medida requerem revisores especializados e habilidade em análise qualitativa. Com grau de recomendação “A”, a Berg Balance Scale (BBS) e o teste Timed Up and Go (TUG) foram os instrumentos mais indicados na DPOC. Ao acrescentar a avaliação da utilidade clínica ao resultado, o TUG demonstra superioridade ao BBS, demostrando ser uma ótima ferramenta para triar indivíduos que necessitem de uma avaliação minuciosa do equilíbrio, quedas e risco de quedas.
... Another potential factor is that COPD patients may experience balance problems caused by either muscle weakness or impaired proprioception (sense of body position) [25]. Balance issues can lead to an unsteady gait and an increased risk of falls [26]. ...
Chronic obstructive pulmonary disease (COPD) is a progressive lung condition characterized by airflow limitation and respiratory symptoms such as shortness of breath, chronic cough, and sputum production. The relationship between COPD and gait disturbance is orchestrated by a complex interplay of factors. Airflow obstruction, the hallmark of COPD, imposes a strain on the respiratory system, leading to breathlessness and fatigue. This relentless struggle for breath forces individuals with COPD to curtail their walking pace, where they adopt a shortened stride and reduced step height. Furthermore, the chronic inflammation associated with COPD infiltrates skeletal muscles, leading to muscle weakness and decreased muscle mass. This insidious process further impairs gait, diminishing the ability to generate the necessary force for efficient ambulation. This chapter will explore the connection between COPD and gait disturbance, examining the underlying mechanisms, prevalence, impact, and management strategies to prevent fall-related injuries and improve the well-being of individuals affected by this challenging combination.
... [4,5]. Peripheral muscle weakness, systemic inflammation, physical inactivity, and decreased exercise capacity affect balance in patients with COPD [6][7][8]. Clinical studies have shown that patients with COPD have limitations in functional capacity and balance compared to healthy individuals [7,9,10]. It has been reported that patients with COPD often experience functional performance deficits that affect their postural stability and balance due to lower extremity muscle weakness, an inability to manage symptoms, a worsening ability to adapt to the disease, and reduced physical activity levels [7,9,11]. ...
... In a comprehensive study characterizing proprioceptive postural control in COPD, it was found that patients used more ankle muscle proprioceptive signals and less back muscle proprioceptive signals during balance control [12]. Furthermore, achieving successful balance depends not only on motor performance but also on mental awareness, the individual's ability to harmonize with the environment and space, and the effective use of proprioceptive inputs [8,11,12]. Increased loss of balance may constitute a potential risk factor for the possibility of falls in patients with COPD [13]. Lower extremity muscle weakness and loss of balance ability are the two main factors that cause falls in COPD patients [13,14]. ...
Background
Assessment of extrapulmonary comorbidities is essential in chronic obstructive pulmonary disease (COPD). Deterioration of balance and increasing fear of falling are two of the most significant extrapulmonary manifestations. Although pulmonary rehabilitation (PR) is well-known and effective for COPD patients, there is a need for alternative treatments to enhance balance and alleviate concerns about falling. This study aimed to investigate the effect of Body Awareness Therapy (BAT), in addition to the PR program, on balance and fear of falling in patients with COPD.
Methods
Forty-three patients were randomized into two groups: the BAT + PR group (BAT: once a week, 60 min + PR: 30 min, seven days of the week) or the PR group (PR: 30 min, seven days of the week) for eight weeks. Primary (balance, fear of falling) and secondary (dyspnea, muscle strength, functional capacity) outcomes were assessed at two different times: the baseline and end of the eight weeks.
Results
Significant improvements were found in dynamic balance (reaction time η² = 0.777, movement velocity η² = 0.789, endpoint excursion η² = 0.687, maximal excursion η² = 0.887), static balance on firm ground (eyes opened η² = 0.679, eyes closed η² = 0.705), dyspnea (η² = 0.546), muscle strength (η² = 0.803), and functional capacity (η² = 0.859) of the BAT + PR group (p < 0.05 for all). The improvement in fear of falling was significantly greater in the BAT + PR group than in the PR group (p < 0.001, η² = 0.331).
Conclusion
The BAT method added to PR was more effective than PR alone in improving balance and reducing the fear of falling in COPD patients.
Trial registration
This randomized controlled study was registered at clinicaltrials.gov, NCT04212676, Registered 28 December 2019.
... In this regard, the COPD Assessment Test (CAT) and the Modified British Medical Research Council (mMRC) dyspnea scale serve as pivotal tools [10,11]. The CAT, a patient-completed instrument, provides a measure of the health status of individuals with COPD, allowing for an assessment of the impact of the disease on the patient's well-being [12][13][14]. On the other hand, the mMRC dyspnea scale facilitates the evaluation of the breathlessness experienced by COPD patients, a significant indicator of exacerbation severity and frequency [15]. ...
Current research primarily emphasizes the generalized correlations between airborne pollution and respiratory diseases, seldom considering the differential impacts of particular particulate matter sizes on chronic obstructive pulmonary disease (COPD) exacerbations in distinct Global Initiative for Obstructive Lung Disease (GOLD) categories. This study hypothesizes a critical association between particulate matter sizes (PM 1.0, PM 2.5, and PM 10) and exacerbation frequency in COPD patients categorized under GOLD 3 and GOLD 4, with a potential augmenting role played by proximity to main roads and industrial areas. This research aspires to offer a nuanced perspective on the exacerbation patterns in these groups, setting the stage for targeted intervention strategies. Utilizing a prospective design, this study followed 79 patients divided into GOLD 3 (n = 47) and GOLD 4 (n = 32) categories. The participants were monitored for ten days for daily activity levels, symptoms, living conditions, and airborne particulate matter concentrations, with spirometric evaluations employed to measure lung function. Statistical analyses were used to identify potential risk factors and significant associations. The analysis revealed substantial disparities in airborne particulate matter sizes between the two groups. The mean PM 1.0 concentration was notably higher in GOLD 4 patients (26 µg/m3) compared to GOLD 3 patients (18 µg/m3). Similarly, elevated PM 2.5 levels were observed in the GOLD 4 category (35 µg/m3) in contrast to the GOLD 3 category (24 µg/m3). A vital finding was the increased frequency of exacerbations in individuals residing within 200 m of main roads compared to those living further away (OR = 2.5, 95% CI: 1.5–4.1). Additionally, patients residing in homes smaller than 50 square meters demonstrated a greater frequency of exacerbations. Spirometry results corroborated the exacerbated condition in GOLD 4 patients, indicating a significant decline in lung function parameters compared to the GOLD 3 group. This study substantiates a significant association between airborne particulate matter sizes and exacerbation frequencies in COPD patients, particularly accentuating the increased risk in GOLD 4 patients. Our findings underscore the pivotal role of environmental factors, including the size of living areas and proximity to main roads, in influencing COPD exacerbations. These results suggest the need for personalized healthcare strategies and interventions, which account for environmental risk factors and the distinctions between GOLD 3 and GOLD 4 categories of COPD patients.
... 42,[61][62][63] Similar to the participants in this study, individuals with COPD also have deficits related to extrapulmonary factors. 30,41,54,64,65 Researchers have found that these individuals had lower pain pressure thresholds 66 and impaired use of sensory information for balance. 42,66,67 Individuals with COPD demonstrate impaired balance and subsequent falls which are linked to sensory changes, such as proprioception 68,69 and verticality, 67 and motor changes. ...
... Research seems to be inconclusive on the relationship between these balance impairments and respiratory function. 49,54,[62][63][64]74,75 The evidence on balance function in individuals with COVID-19 is limited, and no studies use objective measures of balance in hospitalized patients. Yilmaz et al 23 conducted a case-control study where objective assessments of balance, including computerized dynamic posturography, were performed on outpatients recovered from COVID-19. ...
Background and Purpose
Individuals with cardiorespiratory dysfunction demonstrate postural instability and increased risk of falls. Given that coronavirus disease (COVID-19) is commonly defined as a respiratory condition, it could be presumed that these patients may demonstrate similar balance deficits. This study aimed to determine deficits and characterize balance dysfunction (sensory or motor) in hospitalized patients classified as “COVID-19 recovered.”
Methods
Twenty-five participants consented for this study. Participants completed the Activity-Specific Balance Confidence Scale (ABC), a questionnaire about dizziness, the Timed “Up & Go” (TUG), and the modified Clinical Test of Sensory Interaction and Balance in a single session. The percentage of subjects who scored abnormal on the outcome measures was calculated. Correlations between demographics, respiratory function, and clinical outcome measures were determined using Spearman correlation coefficient.
Results
All participants had abnormal scores on the TUG, 88% had abnormal scores on the ABC, and 48% of the subjects had abnormal scores on standing on foam eyes closed indicating difficulty using vestibular information. No correlation coefficient above 0.50 was found between the demographic information, respiratory function, and clinical outcome measures.
Discussion
Clinical outcome measure scores did not correlate with respiratory function indicating that the deficits may be due to the extrapulmonary components of COVID-19.
Conclusion
Both young and older adults presented with motor and sensory balance deficits acutely after COVID-19 infection. It is recommended that individuals acutely post–COVID-19 receive education and interventions to increase mobility, improve balance, decrease fall risk, and specifically receive activities that stimulate the vestibular system.
... CPD are usually characterised by high dyspnoea levels, low tolerance for physical activity and exercise and reduced mobility [3], which are leading causes of disability [4]. Moreover, research has highlighted that patients living with CPD are more likely to (i) develop symptoms related to anxiety and depression [5]; (ii) have poorer quality of life compared to healthy people [6]; (iii) have balance-related problems, such as falls [7,8]; and (iv) spend less time engaging in daily physical activity than healthy people [9]. Idiopathic pulmonary fibrosis (IPF) is a rare, chronic, progressive, fibrosing interstitial pneumonia of unknown aetiology and is an incurable disease [10]. ...
Background:
Physical activity (PA) is recommended in the management of patients with pulmonary fibrosis (PF) to improve health outcomes. Dance is one such form of PA which is meaningful, valuable, enjoyable and has demonstrated positive physical and mental health effects.
Methods:
With pre-post design, 16 patients, members of the Irish Lung Fibrosis Association, were enrolled in this study. Once weekly, 75-min dance sessions were delivered for eight weeks via Zoom by an experienced choreographer. Participants completed Chronic Respiratory Questionnaire Self-Administered Standardised Format (CRQ-SAS) and European Quality of Life 5 Dimensions 3 Level Version (EQ-5D-3L) to assess self-rated quality of life. A paired-sample t-test was employed to assess the mean differences between the pre-and post-intervention scores.
Results:
Most patients (78.57%) were aged over 60 years; with 71.43% diagnosed with pulmonary fibrosis more than 3 years ago. We performed an analysis of 10/16 participants who completed the intervention (5 males, 5 females). On CRQ-SAS scale we found, (a) dyspnoea-small to moderate magnitude improvement of 0.5-1.0 among 50%, (b) fatigue-small to moderate magnitude improvement of 0.5-1.0 among 40%, (c) emotional function-small to high magnitude improvement of 0.5-2.0 among 50%, (d) mastery-small magnitude improvement of 0.5 among 20%. Participants reported their health moderate to best on Visual Analogue Scale of EQ-5D-3L which improved by 1-3 scale among 40%. Mental health improved as percentage of not feeling anxious or depressed rose post event from 42.86% to 72.73%.
Conclusion:
Our findings demonstrate that a virtual dance intervention is acceptable, enjoyable and feasible for improving health outcomes among PF patients. More organised and continuous events in future may reveal cost-benefit ratio and impact on health outcomes.
... The FEV1 of the participants ranged from 27.5% to 59%. Of the included studies, eleven studies used the TUG as a method of assessment in relation to the risk of falls [37,39,40,42,44,[46][47][48][49][50]52], nine studies included the BBS as a method of evaluation [35, 37-39, 41, 43, 49, 50, 57], and seven studies included the UST as a method of evaluation [37, 39, 48-50, 52, 56]. Regarding functional capacity, seventeen studies evaluated 6MWT [36, 39, 40, 42, 44, 48-51, 53-55, 57-61]. ...
... Eleven studies used TUG as a measure of balance to compare people with stable COPD with healthy controls [37,39,40,42,44,[46][47][48][49][50]52]. COPD: 880 participants vs Control: 412 participants. ...
... Seven studies used the UST [37,39,49,50], and one study used the tandem posture [45] as a measure of static balance to compare people with stable COPD with healthy controls. Figure 3D). ...
The objective of this study is to compare the balance and functional capacity between stable Chronic Obstructive Pulmonary Disease (COPD) patients versus healthy controls using clinical tests. A comprehensive search of PubMed/MEDLINE, the Cochrane Central Register of Controlled Trials (CENTRAL), Embase, and Web of Science was conducted from inception to 21 January 2022. Studies reporting the association between COPD status and balance or functional capacity using clinical tests were included. Two independent reviewers examined the titles and abstracts, extracted the data using a standardised form, and assessed the risk of bias of the included articles. A total of 27 studies with 2420 individuals with stable COPD were included. Overall, the risk of bias in the included studies was low to moderate. The meta-analysis showed a higher history of falls in individuals with COPD (Odds Ratio: 1.59 [95%CI: 1.25–2.02]). Furthermore, an overall effect in favour of the healthy controls was observed in the Timed Up and Go (mean difference: 2.61 s [95%CI: 1.79–3.43]), Berg Balance Scale (mean difference: −6.57 points [95%CI: −8.31 to −4.83]), static balance tests (standardised mean difference: −1.36 [95%CI: −2.10 to −0.62]), and the 6-minute walk test (mean difference: −148.21 meters [95%CI: −219.37 to −77.39]). In conclusion, individuals with stable COPD have worse balance and functional capacity compared to healthy controls. These results may guide clinicians to elaborate on therapeutic strategies focused on screening of balance and functional impairments. This is in addition to generating rehabilitation guidelines aimed at reducing the risk of falling in people with COPD.
... COPD does aggravate balance deficits, through a combination of altered postural activity of the trunk muscles [15], lower extremity muscle weakness, decreased levels of physical activity [16], and somatosensory deficits [19], and higher postural and functional balance impairments have been observed in individuals with COPD compared to healthy/control subjects [42][43][44][45]. Reduced exercise tolerance, gait speed, muscle force, and lung capacity, as well as the presence of comorbidities, history of exacerbations, and the use of oxygen therapy, are all potential risk factors underlying these balance impairments [42][43][44][45]. ...
... COPD does aggravate balance deficits, through a combination of altered postural activity of the trunk muscles [15], lower extremity muscle weakness, decreased levels of physical activity [16], and somatosensory deficits [19], and higher postural and functional balance impairments have been observed in individuals with COPD compared to healthy/control subjects [42][43][44][45]. Reduced exercise tolerance, gait speed, muscle force, and lung capacity, as well as the presence of comorbidities, history of exacerbations, and the use of oxygen therapy, are all potential risk factors underlying these balance impairments [42][43][44][45]. The higher balance deficits among females with COPD reported in the present study can be attributed to the more frequent use of oxygen therapy, reduced exercise tolerance, and decreased lung function. ...
No previous research has examined age and sex differences in balance outcomes in individuals with chronic obstructive pulmonary disease (COPD) at risk of falls. A secondary analysis of baseline data from an ongoing trial of fall prevention in COPD was conducted. Age and sex differences were analyzed for the Berg Balance scale (BBS), Balance Evaluation System Test (BEST test) and Activities-specific Balance Confidence Scale (ABC). Overall, 223 individuals with COPD were included. Females had higher balance impairments than males [BBS: mean (SD) = 47 (8) vs. 49 (6) points; BEST test: 73 (16) vs. 80 (16) points], and a lower confidence to perform functional activities [ABC = 66 (21) vs. 77 (19)]. Compared to a younger age (50–65 years) group, age >65 years was moderately associated with poor balance control [BBS (r = − 0.37), BEST test (r = − 0.33)] and weakly with the ABC scale (r = − 0.13). After controlling for the effect of balance risk factors, age, baseline dyspnea index (BDI), and the 6-min walk test (6-MWT) explained 38% of the variability in the BBS; age, sex, BDI, and 6-MWT explained 40% of the variability in the BEST test; And BDI and the 6-MWT explained 44% of the variability in the ABC scale. This study highlights age and sex differences in balance outcomes among individuals with COPD at risk of falls. Recognition of these differences has implications for pulmonary rehabilitation and fall prevention in COPD, particularly among females and older adults.
