Effets d’un programme de réhabilitation respiratoire sur l’équilibre de patients atteints de BPCO

Exercise-based interventions targeting balance and falls in people with COPD: a systematic review and meta-analysis

INTRODUCTION

This review quantifies the mean treatment effect of exercise-based interventions on balance and falls risk in people with COPD.

METHODS

A structured search strategy (2000-2023) was applied to eight databases to identify studies evaluating the impact of exercise-based interventions (≥14 days in duration) on balance or falls in people with COPD. Pooled mean treatment effects (95% confidence intervals (CIs), 95% prediction intervals (PIs)) were calculated for outcomes reported in five or more studies. Inter-individual response variance and the promise of behaviour change techniques (BCTs) were explored.

RESULTS

34 studies (n=1712) were included. There were greater improvements in balance post intervention compared to controls for the Berg Balance Scale (BBS) (mean 2.51, 95% CI 0.22-4.80, 95% PI -4.60-9.63), Timed Up and Go (TUG) test (mean -1.12 s, 95% CI -1.69- -0.55 s, 95% PI -2.78-0.54 s), Single-Leg Stance (SLS) test (mean 3.25 s, 95% CI 2.72-3.77 s, 95% PI 2.64-3.86 s) and Activities-specific Balance Confidence (ABC) scale (mean 8.50%, 95% CI 2.41-14.58%, 95% PI -8.92-25.92%). Effect on falls remains unknown. Treatment effects were larger in male versus mixed-sex groups for the ABC scale and SLS test, and in balance training versus other exercise-based interventions for the BBS and TUG test. Falls history was not associated with changes in balance. Meta-analysis of individual response variance was not possible and study-level results were inconclusive. Eleven promising BCTs were identified (promise ratio ≥2).

CONCLUSION

Evidence for the effect of exercise-based interventions eliciting clinically important improvements in balance for people with COPD is weak, but targeted balance training produces the greatest benefits. Future exercise interventions may benefit from inclusion of the identified promising BCTs.

Minimal Detectable Change for Balance Measurements in Patients With COPD

PURPOSE

The purpose of this study was to determine the reliability and minimal detectable change (MDC) of various outcome measures that are potentially suitable for evaluating postural control in individuals with chronic obstructive pulmonary disease (COPD).

METHODS

This was a test-retest reliability study. Participants with COPD were asked to complete 5 balance assessments, separated by 1 week. The assessments included Timed Up and Go (TUG) Test, Unipodal Stance Test (UST), Tinetti Test, Berg Balance Scale (BBS), and the Activities Balance Confidence (ABC) scale. Test-retest reliability using intraclass correlation coefficients and MDC values were calculated for each assessment.

RESULTS

All 5 outcome measures were found to have excellent test-retest reliability (r > 0.90). The MDC95 values were 3.01 seconds and 4.03 seconds for the TUG Test and the UST, respectively; 3.23 points and 3.46 points for the Tinetti Test and the BBS, respectively; and 8.25% for the ABC scale.

CONCLUSION

The TUG, UST, BBS, the Tinetti Test, and the ABC scale are reliable outcome measures for use with people with COPD, recognizing that individual variability of performance is high. Minimal detectable change scores at the 95% CI can be used to assess change in performance over time and the impact of interventions in this population.