Assessment and Management of Balance Impairment and Fall Risk in Individuals with Chronic Obstructive Pulmonary Disease (COPD)

Abstract

Accumulating evidence has demonstrated that individuals with chronic obstructive pulmonary disease (COPD) have balance deficits and high incidence of falls. As falls could have devastating consequences, identifying fall risk factors and individuals who are at risk of falls are needed, so that optimal fall prevention interventions could be designed and implemented. It has been suggested that balance training should be part of pulmonary rehabilitation (PR) program for individuals with COPD. However, there has been limited evidence on the benefits of such program. The first study aimed to systematically review balance impairment and effectiveness of exercise interventions in improving balance performance and reducing fall risk in individuals with COPD. Four databases (i.e. Scopus, CINAHL, PubMed, and Cochrane Library) with 24 key words related to COPD, balance impairment, and exercise intervention were used in search strategy. The result of the 15 included studies revealed that individuals with COPD had poorer balance performance as measured by three balance approaches (i.e. functional, systematic, and quantitative laboratory approaches) than those with non-COPD. Further, the findings from four randomized controlled trials (RCTs) suggested that intervention strategies including adding balance training to the PR program, Tai Chi, and cycling exercise programs might be effective in improving balance in individuals with COPD. The second study aimed to examine physiological impairments contributing to fall risk in 114 individuals with COPD compared to 57 individuals with non-COPD. All participants underwent fall risk assessment using the Physiological Profile Assessment (PPA) which included 5 subdomains (i.e. visual contrast sensitivity, proprioception, quadriceps muscle strength, reaction time, and postural sway). In addition, the Timed-Up and Go (TUG) was used to evaluate functional balance performance. The results showed that individuals with COPD had significantly poorer performance in all subdomains of PPA and had higher risk of falls than those with non-COPD (all p < 0.05). Further, they took significantly longer time to complete TUG than the non-COPD participants (p < 0.05). There was a moderate correlation between the PPA composite score and the TUG score (r = 0.046, p < 0.001).The third study aimed to investigate the effectiveness of home-based balance training incorporated with PR program on balance and fall risk in individuals with COPD. Forty-eight individuals with COPD who had impaired balance were randomly allocated into the home-based balance training incorporated with PR program and the home-based PR program (24 per group). The training frequency was 3 sessions per week for 8 consecutive weeks with the duration of 45 and 65 minutes per session for the PR and PR plus balance group, respectively. Primary outcomes were balance performance and fall risk, and secondary outcomes were balance confidence, dyspnea level, exercise capacity, and disease-related symptoms related to quality of life. These outcomes were assessed at baseline and after 8-week of training. The results revealed that participants in the home-based balance training incorporated with PR group demonstrated significantly better balance performance and lower fall risk than those in the home-based PR program alone (p < 0.05). For the secondary outcomes, there were significant improvements in balance confidence, exercise capacity, and disease-related symptoms in the home-based balance training incorporated with PR program compared to the home-based PR program alone (p < 0.05).The overall findings of this thesis confirm previous findings that individuals with COPD had balance impairment and increased fall risk which emphasize the need for identifying balance impairment and fall risk in individuals with COPD. Further, the study findings provide evidence that homed-based balance training incorporated with standard PR program is feasible and beneficial for balance improvement and fall risk reduction, thus, may be considered as alternative to hospital-based and PR alone program particularly for individuals with COPD who have balance deficits.