Balance assessment in people with COPD: An evidence-based guide

Postural balance in COPD with obstructive sleep apnoea: a cross-sectional study

Objective

The aim of this study was to assess the postural balance in COPD patients with obstructive sleep apnoea (OSA). Physical activity, anxiety and depression symptoms, mood, and falls were also assessed in this population.

Methods

Moderate to severe COPD patients were assessed for laboratory and clinical postural balance (force platform and mini-balance evaluation systems test (Mini-BESTest)), physical activity (accelerometry), OSA (polysomnography), sleep quality (Pittsburgh Sleep Quality Index), sleepiness (Epworth Sleepiness Scale), anxiety and depression symptoms (Hospital Anxiety and Depression Scale), dyspnoea (modified Medical Research Council), clinical status (COPD Assessment Test) and mood (Brunel Mood Scale). Self-reported falls were recorded for 6 months via phone calls.

Results

COPD patients (n=70) were divided according to the polysomnography findings into the no OSA (n=30), mild OSA (n=25), and moderate to severe OSA (n=15) groups. Compared to patients with no OSA, those with moderate to severe OSA (msOSA group) presented median (interquartile range) increased path length (30.5 (23.9-34.5) cm versus 39.0 (30.6-52.6) cm, anteroposterior displacement (1.89 (1.39-2.31) cm versus 2.54 (2.06-2.83) cm and postural adjustment velocity (1.02 (0.80-1.15) cm·s-1 versus 1.30 (1.02-1.76) cm·s-1) (p<0.05). No differences were observed in the Mini-BESTest scores among the groups. The msOSA group presented a greater number of recurrent fallers in the first follow-up trimester. No association was observed between postural balance and age and pulmonary function.

Conclusion

Individuals with COPD and moderate to severe OSA present changes in postural balance, including broader oscillation, faster postural adjustments and a greater risk of falls than those with no OSA. Physical activity, anxiety and depression symptoms, and mood are similar between COPD patients with and without OSA.

Respiratory Muscle Training and Its Impact on Balance and Gait in Patients with Severe COPD

Background and Objectives: Improving extrapulmonary symptoms in COPD through respiratory muscle training can help alleviate the burden of respiratory symptoms, reduce fatigue, and improve exercise capacity in patients with COPD. This, in turn, can enhance physical activity, balance, and gait, ultimately improving the overall quality of life for individuals with COPD. This study aimed to investigate the effects of respiratory muscle training on balance and gait in patients with moderate to severe COPD. Materials and Methods: We included 65 patients with moderate to severe COPD randomly assigned to either the pulmonary rehabilitation protocol group (PR) or the pulmonary rehabilitation and inspiratory muscle training group (PR + IMT) for three weeks. Patients performed a spirometry, maximal inspiratory and expiratory pressure (MIP/MEP), 6 min walking test (6MWT), activities-specific balance confidence (ABC) scale questionnaire, Berg Balance Scale (BBS), timed up and go test (TUG), and single-leg stance test (SLS). Results: Rehabilitation had a notable impact on MIP in Group 2 (PR + IMT), with a highly significant difference between pre- and post-rehabilitation distributions (p < 0.0001). At the same time, Group 1 (PR-only) showed no significant changes (p = 0.27). In Group 1 (Control), pre- and post-rehabilitation comparisons reveal slight non-significant changes for SLS EO (p = 0.16), ABC (p = 0.07), TUG (p = 0.06), and BBS (p = 0.13). In contrast, in Group 2 (Cases), there are significant improvements in all variables after rehabilitation compared to the pre-rehabilitation values: SLS EO (p < 0.0001), ABC (p < 0.0001), TUG (p < 0.0001), and BBS (p < 0.0001). Conclusions: Our research demonstrated that respiratory muscle training significantly positively impacts balance and gait performance among patients with moderate to severe COPD compared to a control group.

Balance-Associated Tests Contribute to Predicting the Need for Ambulatory Assistive Devices (AAD) among Community-Dwelling Older Adults

This study aims to analyze the use of ambulatory assistive devices (AAD) in relation to balance-associated tests and assist medical staff in providing professional objective reference values for older adults on whether to use AAD. Older adults (n = 228) were recruited from the local community to participate in this study. Participants were divided into the AAD-use group and the non-AAD-use group. Four balance-associated tests and scales were applied to predict the relationship between balance function and the use of AAD in older adults. They were used to assess the participant's balance function and confidence in maintaining balance and were considered the most reliable measures of balance. There were significant differences in the Berg Balance Scale (BBS) score and Timed Up and Go Test (TUGT) among the subjects in the AAD-use group and non-AAD-use group (p < 0.001). The ROC curve analysis presented the following cut-off values for balance tests and scales: 23.62 s for the TUGT test and 41.5 points for the BBS score. For example, if the TUGT score is greater than 23.62 s and the BBS score is below 41.5 points, AAD is recommended for older adults to maintain balance and prevent falls. These objective reference standards may be useful in guiding medical personnel to determine whether older adults need to use AAD. In future studies, we hope to include more participants for subgroup analysis, investigating different types of AAD and their effects on older adults.

Pharmacological, Nutritional, and Rehabilitative Interventions to Improve the Complex Management of Osteoporosis in Patients with Chronic Obstructive Pulmonary Disease: A Narrative Review

Osteoporosis is a highly prevalent condition affecting a growing number of patients affected by chronic obstructive pulmonary disease (COPD), with crucial implications for risk of fragility fractures, hospitalization, and mortality. Several risk factors have been identified to have a role in osteoporosis development in COPD patients, including corticosteroid therapy, systemic inflammation, smoke, physical activity levels, malnutrition, and sarcopenia. In this scenario, a personalized multitarget intervention focusing on the pathological mechanisms underpinning osteoporosis is mandatory to improve bone health in these frail patients. Specifically, physical exercise, nutritional approach, dietary supplements, and smoke cessation are the cornerstone of the lifestyle approach to osteoporosis in COPD patients, improving not only bone health but also physical performance and balance. On the other hand, pharmacological treatment should be considered for both the prevention and treatment of osteoporosis in patients at higher risk of fragility fractures. Despite these considerations, several barriers still affect the integration of a personalized approach to managing osteoporosis in COPD patients. However, digital innovation solutions and telemedicine might have a role in optimizing sustainable networking between hospital assistance and community settings to improve bone health and reduce sanitary costs of the long-term management of COPD patients with osteoporosis.

Video game-based exercise in children and adolescents with non-cystic fibrosis bronchiectasis: A randomized comparative study of aerobic and breathing exercises

BACKGROUND

Video game-based systems have been proposed to improve effectiveness and compliance with exercise training in children and adolescents with noncystic fibrosis bronchiectasis (NCFB). This study aimed to investigate the effects of aerobic and breathing video game-based exercises (VGE) on pulmonary function, respiratory and peripheral muscle strength, functional capacity, and balance in children and adolescents with NCFB.

METHOD

Thirty-nine children and adolescents aged between 8 and 18 years with NCFB were randomly allocated into three groups as "home-based chest physiotherapy group" (CP), "aerobic VGE given in addition to home-based chest physiotherapy group" (CP + aerobic VGE), and "breathing VGE given in addition to home-based chest physiotherapy group" (CP + breathing VGE). All three groups performed chest physiotherapy program twice a day for 7 days per week for 8 weeks. Pulmonary function, respiratory and peripheral muscle strength, functional capacity, and balance were assessed at baseline and after 8 weeks of training.

RESULTS

The improvement in maximum expiratory pressure and balance scores were significantly higher in both CP + aerobic and CP + breathing VGE groups. The significant improvement in maximum inspiratory pressure was greater in the CP + breathing VGE group. The changes in peripheral muscle strength and functional capacity were significantly higher in the CP + aerobic VGE group.

CONCLUSIONS

The present study showed that aerobic VGE provides additional benefits in improving peripheral muscle strength and functional capacity, while breathing VGE provides further increase in improving respiratory muscle strength. In addition, both aerobic and breathing VGE were effective in improving balance, but they were not superior to each other.

The effectiveness of home-based balance and pulmonary rehabilitation program in individuals with chronic obstructive pulmonary disease: a randomized controlled trial

BACKGROUND

Balance impairment and increased fall risk have been demonstrated in individuals with chronic obstructive pulmonary disease (COPD). However, studies investigating the effects of balance training especially when combined with pulmonary rehabilitation (PR) program in home-based setting are scarce.

AIM

To examine whether adding balance training to home-based pulmonary rehabilitation improves balance, fall risk, and disease-related symptoms in individuals with COPD.

DESIGN

Randomized, controlled, assessor-blinded trial with parallel two-group design.

SETTING

Home-based setting.

POPULATION

Forty-eight individuals diagnosed with COPD.

METHODS

Participants with COPD were randomly allocated to either a home-based PR or home-based balance training combined with PR (PR-BT) group (24 per group). Both groups exercised three days per week for eight-week. Primary outcomes were fall risk index and functional balance as measured by the Physiological Profile Assessment (PPA) and Timed Up and Go (TUG), respectively. Secondary outcomes were the Activities-specific Balance Confidence (ABC), Modified Medical Research Council dyspnea (mMRC), Six-Minute Walk Test (6MWT), and COPD assessment test (CAT). All outcome measures were assessed at baseline, post-intervention, and three-month follow-up.

RESULTS

All participants completed the trial, with no reported adverse events. At post-intervention, the PR-BT group demonstrated significantly greater improvements in PPA fall risk score (PR-BT: 1.1±0.8, PR: 2.4±1.5), TUG (PR-BT: 10.7±1.3, PR: 14.4±4.4 s) and these improvements remained at three-month follow-up (all P<0.01). The ABC, mMRC, and CAT scores were also significant better for the PR-BT than the PR group both after intervention and at three-month follow-up (all P<0.05).

CONCLUSIONS

Eight-week home-based balance and PR program is effective in improving balance as well as dyspnea, and well-being in individuals with COPD.

CLINICAL REHABILITATION IMPACT

Home-based balance and PR program is a promising approach for COPD rehabilitation especially in patients who are at risk of falls.

Balance performance in patients with post-acute COVID-19 compared to patients with an acute exacerbation of chronic obstructive pulmonary disease and healthy subjects

COVID-19 leaves important sequelae in patients, not only in those who had the experience of a critical illness but also in patients with severe form. Understanding the impairments allows us to target rehabilitation to patients' real needs; balance impairments are an assumed sequela of COVID-19, but no study has specifically evaluated balance performance in these patients. Their performance was compared to that of patients with a pulmonary disease that leads to systemic diseases, such as patients with an acute exacerbation of chronic obstructive pulmonary disease (PwAECOPD), and of healthy subjects. A total of 75 subjects were assessed: 25 patients with COVID-19 (PwCOVID) with a severe form in the acute phase, 25 PwAECOPD and 25 healthy subjects sex- and age-matched. A stabilometric platform was used to evaluate static balance, both with eyes open and closed, while the dynamic balance was assessed with the Mini-BESTest and the Timed Up and Go test. When compared to healthy subjects, results showed that PwCOVID had worse performance in both static (P < 0.005) and dynamic (P < 0.0001) balance, with a large effect size in all measures (>0.8). Moreover, PwCOVID showed similar results to those of PwAECOPD. In conclusion, PwCOVID showed a balance deficit in both dynamic and static conditions. Therefore, as for PwAECOPD, they should require not only respiratory rehabilitation but also balance and mobility physiotherapy to prevent today's PwCOVID from becoming tomorrow's fallers.

Balance Function in Patients With COPD: A Systematic Review of Measurement Properties

To conduct an overview, evaluation, and synthesis of measurement properties of instruments assessing balance of COPD patients. Electronic searches were performed in Web of Science, Scopus, Embase, PubMed, CINAHL, PsycINFO, WanFang, and China National Knowledge Infrastructure databases up to the end of April 2021. Two reviewers independently evaluated the methodological quality using the Consensus-based Standards for the Selection of Health Status Measurement Instrument checklist, and rated the overall quality level of evidence was graded based upon a modified Grades of Recommendation, Assessment, Development, and Evaluation approach. Finally, 12 instruments were included. The Berg Balance Scale and the Timed Up and Go test were the most frequently used tools to evaluate balance. None of 12 instruments provide any information regarding cross-cultural validation or criterion validation. High-quality studies exploring measurement properties with a focus on the criterion validity and cross-cultural validity of balance measurements in COPD patients are warranted.

Harnessing Digital Health to Objectively Assess Functional Performance in Veterans with Chronic Obstructive Pulmonary Disease

INTRODUCTION

An early detection of impaired functional performance is critical to enhance symptom management for patients with chronic obstructive pulmonary disease (COPD). However, conventional functional measures based on walking assessments are often impractical for small clinics where the available space to administrate gait-based test is limited. This study examined the feasibility and effectiveness of an upper-extremity frailty meter (FM) in identifying digital measures of functional performance and assessing frailty in COPD patients.

METHODS

Forty-eight patients with COPD (age = 68.8 ± 8.5 years, body mass index [BMI] = 28.7 ± 5.8 kg/m2) and 49 controls (age = 70.0 ± 3.0 years, BMI = 28.7 ± 6.1 kg/m2) were recruited. All participants performed a 20-s repetitive elbow flexion-extension test using a wrist-worn FM sensor. Functional performance was quantified by FM metrics, including speed (slowness), range of motion (rigidity), power (weakness), flexion and extension time (slowness), as well as speed and power reduction (exhaustion). Conventional functional measures, including timed-up-and-go test, gait and balance tests, and 5 repetition sit-to-stand test, were also performed.

RESULTS

Compared to controls, COPD patients exhibited deteriorated performances in all conventional functional assessments (d = 0.64-1.26, p < 0.010) and all FM metrics (d = 0.45-1.54, p < 0.050). FM metrics had significant agreements with conventional assessment tools (|r| = 0.35-0.55, p ≤ 0.001). FM metrics efficiently identified COPD patients with pre-frailty and frailty (d = 0.82-2.12, p < 0.050).

CONCLUSION

This study proposes the feasibility of using a 20-s repetitive elbow flexion-extension test and wrist-worn sensor-derived frailty metrics as an alternative and practical solution to evaluate functional performance in COPD patients. Its simplicity and low risk for test administration may also facilitate its application for remote patient monitoring. Furthermore, in settings where the administration of walking test is impractical, for example, when ventilator support is needed or space is limited, FM may be used as an alternative solution. Future studies are encouraged to use the FM to quantitatively monitor the progressive decline in functional performance and quantify outcomes of rehabilitation interventions.

Effects of Exercise-Based Interventions on Fall Risk and Balance in Patients With Chronic Obstructive Pulmonary Disease: A SYSTEMATIC REVIEW

PURPOSE

Chronic obstructive pulmonary disease (COPD) is a highly prevalent disease characterized by airflow limitation and is associated with decreased balance and increased fall risk. Since falls are related to increased mortality, interventions targeting balance and fall risk could reduce morbidity and mortality. The objective of this review was to systematically assess the effects of exercise-based interventions on fall risk and balance in patients with COPD.

METHODS

PubMed, Web of Science, EMBASE, and CINAHL were screened for randomized controlled trails and within-group studies evaluating effects of exercise-based interventions on fall risk or balance in patients with COPD. Data were presented in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement.

RESULTS

Fifteen studies were identified, 6 randomized controlled trails and 9 within-group studies. All interventions reported positive effects on balance outcomes. No studies reported fall risk. Taking current recommendations of balance outcome measures in patients with COPD into account, pulmonary rehabilitation combined with balance training had the highest effect size. Nine papers had concerns regarding bias, mostly due to the lack of blinding outcome assessors.

CONCLUSIONS

Exercise-based interventions have a positive effect on balance in patients with COPD. Pulmonary rehabilitation with balance training seems to have the most beneficial effect on balance. The effects on fall risk, as well as the long-term intervention effects remain unclear. A standardized balance assessment and research on long-term effects and fall risk are recommended.

Static and dynamic balance impairment and relationship with disease-related factors in patients with chronic obstructive pulmonary disease : A cross-sectional study

BACKGROUND

Disease and aging-related factors may predispose chronic obstructive pulmonary disease (COPD) patients to impaired balance, although the underlying determinants of impaired balance in COPD patients are still unknown. The purpose of this study was to identify the determinants of impaired balance in COPD patients. Also, we aimed to determine which balance measures (clinical or laboratory tests) are more indicative in determining balance impairment in these patients.

METHODS

This cross-sectional study recruited 24 patients with moderate to severe COPD and 24 age-matched healthy subjects. Participants were evaluated regarding demographic and clinical data, previous falls history, lower limb muscle strength, exercise capacity, physical activity and balance level.

RESULTS

COPD patients exhibited significantly a longer test duration on timed up and go test, a higher sway index on the postural stability and lower directional control score on the limit of stability of Biodex balance system (all, p < 0.001) compared to healthy controls, whereas there was no difference in Berg balance scale score between groups (p > 0.05). Balance impairment of the patient group was significantly associated with nonpulmonary conditions, such as physical activity level, exercise capacity, lower limb muscle strength, and with fall history. Also, COPD patients represented significantly lower physical activity level and exercise capacity, weaker lower limb muscle strength than healthy controls (all, p < 0.001).

CONCLUSIONS

Patients with moderate to severe COPD exhibit apparently important reductions in balance control that is directly associated with nonpulmonary consequences and fall history. These results may be extremely important to fall prevention and to guide the development of interventions for this population.

Short Physical Performance Battery: Response to pulmonary rehabilitation and minimal important difference estimates in patients with chronic obstructive pulmonary disease

OBJECTIVE

To determine the response to a pulmonary rehabilitation (PR) program and minimal important differences (MIDs) for the Short Physical Performance Battery (SPPB) subtests and SPPB summary score in patients with Chronic Obstructive Pulmonary Disease (COPD).

DESIGN

Retrospective analysis using distribution- and anchor-based methods.

SETTING

PR center in the Netherlands including a comprehensive 8-week inpatient and 14-week outpatient program of 40 sessions.

PARTICIPANTS

632 patients with COPD (age: 65±8 years, 50% male, FEV₁: 43 (27-47) % predicted) INTERVENTION: Not applicable.

MAIN OUTCOME MEASURE

Baseline and post PR results of the SPPB, consisting of three balance standing tests, 4-meter gait speed (4MGS) test and 5-repetition sit-to-stand (5STS) test. The chosen anchors were 6-minute walk test and COPD Assessment Test. Patients were stratified according to their SPPB summary scores into a low-performance, moderate-performance or high-performance group.

RESULTS

5STS (∆= -1.14 (-4.20- -0.93) seconds) and SPPB summary score (∆= 1 (0-2) points) improved after PR in patients with COPD. In patients with low-performance at baseline, balance tandem and 4MGS significantly increased as well. Based on distribution-based calculations, the MID estimates range between 2.19-6.33 seconds for 5STS and 0.83-0.96 points for SPPB summary score.

CONCLUSIONS

The 5STS and SPPB summary score are both responsive to PR in patients with COPD. The balance tandem test and 4MGS are only responsive to PR in patients with COPD with a low-performance at baseline. Based on distribution-based calculations, a MID estimate of 1 point for the SPPB summary score is recommended in patients with COPD. Future research is needed to confirm MID estimates for SPPB in different centres.

Feasibility of a 6-Month Home-Based Fall Prevention Exercise Program in Older Adults with COPD

Purpose

Older adults with chronic obstructive pulmonary disease (COPD) have a high risk and rate of falls. Home-based fall prevention exercise programs reduce falls in older adults and may be an alternative approach for people with COPD without access to hospital-based rehabilitation. Therefore, we aimed to determine the feasibility of a home-based fall prevention exercise program in older adults with COPD and to examine the effect of the program on fall-related outcomes at baseline, 3 and 6 months.

Patients and Methods

Adults ≥60 years with COPD at risk for falls participated in a single group study. The intervention was a 6-month home-based fall prevention program which included 40 minutes of independent exercise three times per week, four physiotherapist home visits, bimonthly phone calls, and an optional booster session post-exacerbation. An independent assessor collected outcome measures at home at baseline, 3- and 6-months. Primary feasibility criteria were recruitment and retention rates (≥70%) and exercise adherence (≥60%). Functional outcomes included the Berg Balance Scale (BBS), the Balance Evaluation Systems Test (BESTest), the Activities-Specific Balance Confidence (ABC) scale, the repeated chair-stand test, self-reported function, and fall history.

Results

Thirty-six patients (female 63.8%, mean age 74.4 ± 6.1 years; mean FEV₁ 45.0 ± 13.8% predicted) were enrolled. The recruitment rate was 46.8%, participant retention rate was 69.4%, and exercise adherence rate was 73.6%. Repeated measures ANOVA showed improvements at 3- and 6-months compared to baseline in the BBS (p=0.001) and the BESTest total scores and sub-scores (p=0.001).

Conclusion

The home-based fall prevention exercise program met one of the three pre-specified feasibility criteria (exercise adherence), and improved balance-related measures of fall risk in older adults with COPD. Our findings highlight important opportunities for refinement of the study design prior to undertaking a full-scale trial.

Evaluation of balance in patients with chronic obstructive pulmonary disease with practical tests

INTRODUCTION

Patients with chronic obstructive pulmonary disease (COPD) have impaired balance and hence fall more frequently. Easy application of balance evaluation tests can prevent the loss of time in the outpatient clinic for patients with COPD. In this study, we aimed to compare the efficacy of Berg Balance Scale (BBS), a time-consuming but a widely used test, with other easy-to-perform tests such as the Single Leg Stance (SLS), Five Repetition Sit to Stand (5STS), Four Step Square (FSST), and Timed Up and Go (TUG) tests.

METHODS

A total of 71 patients with COPD and 70 control subjects with matching demographic characteristics were included in the study. All patients undertook pulmonary function tests and their scores of 6-min walk-test (6MWT), modified Medical Research Council (mMRC) dyspnoea scale, COPD assessment questionnaire (CAT) and body mass index (B) were recorded. In addition, the severity of airway obstruction (O), the dyspnoea severity (D) and exercise capacity (E) (BODE) index scores were measured. All patients with COPD were classified into four groups, A to D, based on the GOLD 2017 criteria. All subjects undertook the BBS, SLS, 5STS, FSST and TUG tests.

RESULTS

Balance tests revealed increased balance impairment in patients with COPD in comparison with the control subjects (P < .05). The BBS, SLS, FSST and TUG examinations suggested that balance impairment was frequent in Groups C and D patients with COPD (P < .05). FSST and TUG had the highest correlation with BBS (r = -.812 and -.842 and P < .001 and <.001, respectively). The results of FSST and TUG were the closest to those of BBS test.

CONCLUSIONS

FSST and TUG tests can be applied for the assessment of bodily balance status among patients with COPD in outpatient clinics.

Visuomotor reaction time and dynamic balance in children with cystic fibrosis and non-cystic fibrosis bronchiectasis: A case-control study

OBJECTIVE

Extrapulmonary involvement such as balance and reaction time is unclear in cystic fibrosis (CF) patients. The aim of this study was to evaluate visuomotor reaction time (VMRT) and dynamic balance in children with CF and non-CF bronchiectasis compared to healthy children.

DESIGN/METHODS

Demographic and clinical characteristics were recorded. All children were evaluated with pulmonary function test (PFT) using a spirometer, incremental shuttle walk test (ISWT) for exercise capacity, Fitlight Trainer for VMRT, and functional reach test (FRT) for dynamic balance.

RESULTS

Fourteen children with CF (10.71 ± 2.94 years, 7 females), 17 children with non-CF bronchiectasis (12.75 ± 2.81 years, 8 females), and 21 healthy children (11.36 ± 3.28 years, 11 females) were included. Children with CF had longer total VMRT (P = .027), poorer FRT performance (P = .001), and shorter ISWT distances (P = .03) compared to the children with non-CF bronchiectasis and controls. Although total VMRT was longest in the CF group, there was no significant difference in mean VMRT among the CF, non-CF bronchiectasis, and control groups (P > .05).

CONCLUSION

Dynamic balance and VMRT show greater impairment in children with CF than in children with non-CF bronchiectasis compared to healthy controls. Our findings suggest that VMRT and dynamic balance should be taken into consideration for assessments and exercise programs in pulmonary rehabilitation.

Which Balance Subcomponents Distinguish Between Fallers and Non-Fallers in People with COPD?

Rationale

Chronic obstructive pulmonary disease (COPD) is an increasingly prevalent lung disease linked to dysfunctional balance and an increased risk of falls. The Balance Evaluation Systems Test (BESTest) evaluates the six underlying subcomponents of functional balance. The aim of this study was to determine the specific balance subcomponents and cut-off scores that discriminate between fallers and non-fallers with COPD to guide fall risk assessment and prevention.

Methods

A secondary analysis of cross-sectional data from two prior studies in COPD was performed. Independent samples t-tests were used to explore the differences in the BESTest sub-system scores between fallers and non-fallers. Receiver operating characteristic curves were used to determine the optimal subcomponent cut-off scores that identified fallers, and the area under the curve (AUC) was used to assess test accuracy.

Results

Data from 72 subjects with COPD (mean age, 70.3 ± 7.4y; mean forced expiratory volume in 1 second, 38.9 ± 15.8% predicted) were analyzed. Two BESTest subcomponents, stability limits/verticality (fallers: 75.4%, non-fallers: 83.8%; p=0.002) and postural responses (fallers: 67.5%, non-fallers: 79.7%; p=0.008) distinguished between fallers and non-fallers. Stability limits/verticality had an AUC of 0.70 and optimal cut-off score of 73.8% for identifying fallers; postural responses had an AUC of 0.67 and optimal cut-off score of 69.4%.

Conclusion

The stability limits/verticality and postural responses subcomponents of the BESTest distinguished between fallers and non-fallers with COPD. The stability limits/verticality subcomponent can also be used to identify whether an individual with COPD is at risk of falling using a cut-off score of 73.8%. These findings suggest that specific subcomponents of balance could be targeted to optimize fall risk assessment and prevention in COPD.

Choose your words wisely: Optimizing impacts on standardized performance testing

BACKGROUND

The OPTIMAL theory of motor learning identifies motivational (enhanced expectancies, EE, and autonomy support, AS) and attentional (an external attentional focus, EF) factors that affect motor performance and learning [1]. One implication of this theory is that standardized clinical and laboratory assessments of physical capacity and motor performance that do not incorporate optimizing conditions may underestimate true maximal capabilities. The influence of "optimized" conditions on a clinical-applied test of balance control was examined with healthy participants. Given the motor performance benefits of optimized conditions predicted by the OPTIMAL theory, it was hypothesized that providing participants with information that induced EE, provided them with AS, and promoted their use of EF would reduce balance errors and postural sway.

METHODS

We used as an exemplar assessment, the Balance Error Scoring System (BESS), and center-of-pressure (COP) velocity measurements of postural sway. Participants performed under two different conditions, separated by two days: an optimized (EE, AS, and EF) condition and a control ("neutral") condition, with sample-wide order counterbalancing. In each condition, participants performed three stances (double-leg, single-leg, and tandem) on two support surfaces (firm and foam). Stance order was participant-determined in the optimized condition and, for the control condition, yoked to a participant in the optimized condition.

RESULTS

Participants committed fewer balance errors in the optimized condition than in the control condition (p < .001) and their resultant COP velocity in the optimized condition was lower than that in the control condition (p = .004). BESS scores were correlated with resultant COP velocity (r = .593, p < .001).

SIGNIFICANCE

Our results demonstrated the impact of implementing optimized, as opposed to "neutral" control, conditions for better insight into balance capabilities in normal and challenging situations. Practitioners' roles in mediating test situations and using subtle wording to promote optimized performance may have consequential impacts on motor assessment outcomes.

Chronic Obstructive Pulmonary Disease: Proprioception Exercises as an Addition to the Rehabilitation Process

Respiratory rehabilitation in patients with chronic obstructive pulmonary disease (COPD) is recognized as a cornerstone for the therapeutic path. Physiotherapy involves physical activity with aerobic and anaerobic exercises, which can improve the patient's symptomatic picture, such as motor function, emotional status (depression and anxiety), and improve the pain perception. The training of proprioception is not included in the structure of the exercises proposed by the Global Initiative for Chronic Obstructive Lung Disease (GOLD). The training of proprioception is a very useful strategy for stimulating the cerebellum, a neurological suffering area in patients with COPD. The cerebellum sorts information about pain and emotions, as well as motor stimuli. The article discusses the need to introduce proprioception in respiratory rehabilitation protocols, highlighting the neurological relationships with the management of comorbidities.

Diagnostic ability of the Timed Up & Go test for balance impairment prediction in chronic obstructive pulmonary disease

Background

Balance assessment is now recommended by clinical practice guidelines, specific tests have yet to be suggested. The Timed Up and Go (TUG) test is a simple measure of balance status and functional mobility. Nowadays, we need more data of an optimum cut off point of TUG time for detecting balance impairment in patients with chronic obstructive pulmonary disease (COPD). Thus the aim of this study was to evaluate the diagnostic ability relative to balance impairment of the TUG in subjects with COPD.

Methods

The cross-sectional study was conducted in stable COPD patient at Maharaj Nakorn Chiang Mai Hospital, Chiang Mai, Thailand from November 2015 to October 2017. Balance impairment test was measured using the Berg Balance Scale (BBS), a score of ≤45 indicates balance impairment. The TUG was evaluated using sensitivity, specificity, positive likelihood ratio (LR+), negative likelihood ratio (LR−), Youden’s index, and the area under receiver operating characteristic curve (AUROC) from various points of TUG to identify the optimum cut-off point for detecting balance impairment. Multivariable logistic regressions were performed to identify the optimum cut off point of TUG test time for prediction of balance impairment in COPD.

Results

One hundred and eighteen smoking related COPD subjects 86 (72.9% male) with a mean age of 73.5±8.1 years were included in this study. Univariable analysis showed that the AUROC of TUG test to indicate those who had impaired balance was 0.93 [95% confidence interval (CI): 0.88, 0.98]. A cut off point of TUG test time ≥12 seconds had sensitivity, specificity, LR+, LR−, Youden’s index, and AUROC of 95.8%, 90.4%, 10.01, 0.05, 86.2, and 0.93 for detecting balance impairment, respectively. Multivariable analysis identified the TUG test time ≥12 seconds was the best predictor of balance impairment in COPD patients with adjusted risk ratio (RR) of 25.2 (95% CI: 1.6, 312.0, P=0.021) and, the AUROC was 0.98 (95% CI; 0.96, 1.00).

Conclusions

Our study indicates the TUG test time ≥12 seconds has a high diagnostic ability for balance impairment prediction in COPD. The result supports a potential role for this simple test to be incorporated into routine COPD assessment to stratify patients’ balance.

Risk Factors for Postural and Functional Balance Impairment in Patients with Chronic Obstructive Pulmonary Disease

Reduced balance function has been observed during balance challenging conditions in the chronic obstructive pulmonary disease (COPD) population and is associated with an increased risk of falls. This study aimed to examine postural balance during quiet standing with eyes open and functional balance in a heterogeneous group of COPD and non-COPD (control) subjects, and to identify risk factors underlying balance impairment using a large panel of methods. In COPD and control subjects, who were mostly overweight and sedentary, postural and functional balance were assessed using center-of-pressure displacement in anterior-posterior (AP) and medio-lateral (ML) directions, and the Berg Balance Scale (BBS), respectively. COPD showed 23% greater AP sway velocity (p = 0.049). The presence of oxygen therapy, fat mass, reduced neurocognitive function, and the presence of (pre)diabetes explained 71% of the variation in postural balance in COPD. Transcutaneous oxygen saturation, a history of exacerbation, and gait speed explained 83% of the variation in functional balance in COPD. Neurocognitive dysfunction was the main risk factor for postural balance impairment in the control group. This suggests that specific phenotypes of COPD patients can be identified based on their type of balance impairment.