Balance impairment in patients with COPD

Alexandru Florian Crişan, Cristian Oancea, Bogdan Timar, Ovidiu Fira-Mladinescu, Voicu Tudorache, Alexandru Florian Crişan, Cristian Oancea, Bogdan Timar, Ovidiu Fira-Mladinescu, Voicu Tudorache

Abstract

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 was to compare and quantify functional balance between COPD patients and healthy subjects; to investigate the risk of falls in acute stages of the disease and to identify risk factors that could lead to falls.

Methods: We studied 46 patients with moderate-severe COPD (29 stable and 17 in acute exacerbation--AECOPD) and 17 healthy subjects (control group) having similar demographic data. We analyzed the difference in Berg Balance Scale (BBS), Single Leg Stance (SLS) and Timed Up and Go test (TUG) between these three groups and the correlation of these scores with a number of incriminatory factors.

Results: The presence of COPD was associated with significant worsening of balance tests: BBS (55 control, vs. 53 COPD, vs. 44 AECOPD points p<0.001), TUG (8.6 control vs. 12.3 COPD vs. 15.9 AECOPD seconds. p<0.001), SLS (31.1 control vs. 17.7 COPD vs. 7.2 AECOPD seconds p<0.001) which may be associated with an increased risk of falls. Anxiety and depression were significantly associated with decreased balance test scores; anxiety (2 control vs. 6 COPD vs. 9 AECOPD points p<0.001) depression (2 control vs. 7 COPD vs. 12 AECOPD points p<0.001).

Conclusions: According to our results COPD patients in moderate-severe stages and especially those in exacerbation have a high risk of falls.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1. Correlations between hsCRP values and…
Fig 1. Correlations between hsCRP values and Berg Balance Score in patients with COPD.
Interrupted lines are representing the 95% confidence interval for the regression line.
Fig 2. Correlations between FEV (%) and…
Fig 2. Correlations between FEV (%) and Berg Balance Score in patients with COPD.
FEV (%)—forced expiratory volume, percent from expected. Interrupted lines are representing the 95% confidence interval for regression line.

References

    1. Wouters EF. Chronic obstructive pulmonary disease. 5: systemic effects of COPD. Thorax. 2002;57(12): 1067–1070.
    1. Maltais F, LeBlanc P, Jobin J, Casaburi R. Peripheral muscle dysfunction in chronic obstructive pulmonary disease. Clin Chest Med 2000;21: 665–677.
    1. Smith MD, Chang AT, Seale HE, Walsh JR, Hodges PW. Balance is impaired in people with chronic obstructive pulmonary disease. Gait Posture 2010;31: 456–460. 10.1016/j.gaitpost.2010.01.022
    1. American Geriatrics Society, British Geriatrics Society, and American Academy of Orthopaedic Surgeons Panel on Falls Prevention. Guideline for the prevention of falls in older persons. J Am Geriatr Soc. 2001;49(5): 664–672.
    1. Rubenstein LZ. Falls in older people: epidemiology, risk factors and strategies for prevention. Age Ageing 2006;35: 37–41.
    1. Tinetti ME, Speechley M, Ginter SF. Risk factors for falls among elderly persons living in the community. N Engl J Med. 1988;319(26): 1701–7.
    1. Ozge A, Atis S, Sevim S. Subclinical peripheral neuropathy associated with chronic obstructive pulmonary disease. Electromyogr Clin Neurophysiol 2001;41: 185–91.
    1. Brown AP. Reducing falls in elderly people: A review of exercise interventions. Physiother Theory Pract 1999;15: 59–68.
    1. Tinetti ME, Mendes de Leon CF, Doucette JT, Baker DI. Fear of falling and fall-related efficacy in relationship to functioning among community-living elders. J Gerontol. 1994;49: M140–M147.
    1. Mancini M, Horak FB. The relevance of clinical balance assessment tools to differentiate balance deficits. Eur J Phys Rehabil Med. 2010. June;46(2): 239–248.
    1. Alexander NB. Postural control in older adults. J.Am.Geriatr.Soc 1994;42: 93–108.
    1. Berg K, Norman KE. Functional assessment of balance and gait. Clin.Geriatr.Med 1996;12: 705–723.
    1. Smith MD, Chang AT, Seale HE, Walsh JR, Hodges PW. Balance is impaired in people with chronic obstructive pulmonary disease. Gait Posture. 2010;31(4): 456–460. 10.1016/j.gaitpost.2010.01.022
    1. Casaburi R, Briggs DD, Donohue JF, Serby CW, Menjoge SS, Witek TJ. The Spirometric Efficacy of Once-Daily Dosing With Tiotropium in Stable COPD: A 13-Week Multicenter Trial. Chest. 2000;118(5): 1294–1302.
    1. Rabe KF, Hurd S, Anzueto A, Barnes PJ, Buist SA, Calverley P, et al. Global Initiative for Chronic Obstructive Lung Disease. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: GOLD executive summary. Am J Respir Crit Care Med. 2007;176 (6): 532–555.
    1. Celli BR, Barnes PJ. Exacerbations of chronic obstructive pulmonary disease. Eur Respir J 2007;29: 1224–38.
    1. Langley FA, Mackintosh SFH. Functional balance assessment of older community dwelling adults: A systematic review of the literature. The Internet Journal of Allied Health Sciences and Practice, 2007;5 (4).
    1. ATS Statement: Guidelines for the Six-Minute Walk Test Am J Respir Crit Care Med Vol 166 pp. 111–117, 2
    1. Turcu A, Toubin S, Mourey F, D’Athis P, Manckoundia P, Pfitzenmeyer P. Falls and Depression in Older PeopleService de Gériatrie, Hôpital de Champmaillot, Centre Hospitalier Universitaire, Dijon, France Gerontology 2004;50: 303–308.
    1. Roig M, Eng JJ, Road JD, Reid WD. Falls in patients with chronic obstructive pulmonary disease: A call for further research. Respir Med. 2009;103(9): 1257–1269. 10.1016/j.rmed.2009.03.022
    1. Roig M, Eng JJ, MacIntyre DL, Road JD, FitzGerald JM, Burnset J et al. Falls in people with chronic obstructive pulmonary disease: an observational cohort study. Respir Med. 2011. March; 105(3): 461–469. 10.1016/j.rmed.2010.08.015
    1. Beauchamp MK, Hill K, Goldstein RS, Janaudis-Ferreira T, Brooks D. Impairments in balance discriminate fallers from non-fallers in COPD. Chest 2012;141(6): 1496–1503. 10.1378/chest.11-1708
    1. Spruit MA, Gosselink R, Troosters T, Kasran A, Gayan-Ramirez G, Bogaerts P, et al. Muscle force during an acute exacerbation in hospitalised patients with COPD and its relationship with CXCL8 and IGF-I. Thorax. 2003;58: 752–6.
    1. Kent BD, Mitchell PD, McNicholas WT. Hypoxemia in patients with COPD: cause, effects, and disease progression. International Journal of COPD 2011;6: 199–208. 10.2147/COPD.S10611
    1. Lajoie Y, Gallagher SP. Predicting falls within the elderly community: comparison of postural sway, reaction time, the Berg balance scale and the Activities-specific Balance Confidence (ABC) scale for comparing fallers and non-fallers. Arch Gerontol Geriatr. 2004;38(1): 11–26.
    1. Wust RCI, Degens H. Factors contributing to muscle wasting and dysfunction in COPD patients. International Journal of COPD 2007:2(3) 289–300.
    1. Barry E, Galvin R, Keogh C, Horgan F, Fahey T. Is the Timed Up and Go test a useful predictor of risk of falls in community dwelling older adults: a systematic review and meta- analysis. BMC Geriatrics 2014, 14:14 10.1186/1471-2318-14-14
    1. Oga T, Nishimura K, Tsukino M, Sato S, Hajiro T, Michiaki Mishimaet M. Longitudinal deteriorations in patient reported outcomes in patients with COPD. Respir Med, 2007;101: 146–53.
    1. Bohannon RW. Reference values for single limb stance: a descriptive meta-analysis. Topics Geriatr Rehabil 2006; 22(1): 70–77.
    1. Bean JF, Kiely DK, Leveille SG, Herman S, Huynh C, Fielding R, et al. The 6-minute walk test in mobility-limited elders: what is being measured? J Gerontol A Biol Sci Med Sci. 2002;57: M751–6.
    1. Evans RA, Kaplovitch E, Beauchamp MK, Dolmage TE, Goldstein RS. Is Quadriceps Endurance Reduced in COPD?: A Systematic Review. Chest. 2014. October 23.
    1. Myers AM, Fletcher PC, Myers AH, Sherk W. Discriminative and evaluative properties of the activities-specific balance confidence (ABC) scale. J Gerontol A Biol Sci 1998;53: M287–94.
    1. Studenski S, Duncan PW, Chandler J, Samsa G, Prescott B, Hogue C, et al. Predicting falls: the role of mobility and nonphysical factors. J Am Geriatr Soc. 1994;42: 297–302.
    1. Júlia GS, Samantha MN, Bruna VP, Renata PB, Mauricio J, Valéria AP. Chronic Obstructive Pulmonary Disease Assessment Test in assessing of patients with chronic obstructive pulmonary disease: there is a relationship with activities of daily living and mortality predictor index? a cross-sectional study. Fisioter Pesq. 2013;20(4):379–386.
    1. Mikkelsen RL, Middelboe T, Pisinger C, Stage KB. Anxiety and depression in patients with chronic obstructive pulmonary disease (COPD). A review. Nord J Psychiatry. 2004; 58:65–70.
    1. Biderman A, Cwikel J, Fried AV, Galinsky D. Depression and falls among community dwelling elderly people: a search for common risk factors. J Epidemiol Community Health. 2002;56: 631–6.
    1. Rubenstein LZ, Josephson KR. Falls and their prevention in elderly people: what does the evidence show? Med Clin North Am. 2006;90: 807–24.
    1. Lachman ME, Howland J, Tennstedt S, Jette A, Assmann S, Peterson EW. Fear of falling and activity restriction: The survey of activities and fear of falling in the elderly (SAFE). J Gerontol Psychol Sci 1998;53B: P43–P50.
    1. Arfken CL, Lach HW, Birge SJ, Miller JP. The prevalence and correlates of fear of falling in elderly persons living in the community. Am J Public Health 1994;84: 565–570.
    1. Butcher SJ, Meshke JM, Sheppard MS. Reductions in functional balance, coordination, and mobility measures among patients with stable chronic obstructive pulmonary disease. J Cardiopulm Rehabil. 2004;24: 274–80.
    1. Beauchamp MK, Brooks D, Goldstein RS. Deficits in postural control in individuals with COPD- emerging evidence for an important secondary impairment. Multidisciplinary Respiratory Medicine 2010;5(6): 417–421. 10.1186/2049-6958-5-6-417

Source: PubMed

Patrocinadores y Colaboradores

Condiciones médicas

Intervenciones de drogas

3
Suscribir