Fear of Falling in Patients with Chronic Obstructive Pulmonary Disease: Clinical Associations and Functional Impact

This study aimed to determine the frequency of fear of falling (FOF) in individuals with chronic obstructive pulmonary disease (COPD) and to evaluate its relationship with demographic, clinical, and functional parameters.

Eighty COPD patients followed in a university hospital between May 2021 and December 2022 were included in this cross-sectional study. Perceived fear of falling was assessed with the Falls Efficacy Scale (FES), and functional balance was evaluated using the Berg Balance Scale (BBS). Physical performance was measured using the Timed Up and Go (TUG) test and Six-Minute Walk Test (6MWT). Symptoms were assessed with the COPD Assessment Test (CAT) and modified Medical Research Council Dyspnea Scale (mMRC). Respiratory function was measured using spirometric parameters including Forced Expiratory Volume in 1 second (FEV₁), Forced Vital Capacity (FVC), and the FEV₁/FVC ratio. Data analysis was conducted using SPSS.

The mean age of participants was 64.98±8.13 years, and 91.25% were male. FES scores were significantly higher in patients with fall history (45 [64-73] vs 20 [12-32], p<0.001). FOF was also significantly higher in those with comorbidities, especially hypertension (p=0.024) and heart failure (p=0.036). FOF differed across COPD groups, with Group E patients showing significantly higher FES scores than Groups A and B (59 [28-71.5] vs 16 [10-25] and 29 [14-45], respectively; p<0.001). Based on FEV₁, patients in Stages 3 and 4 had higher FOF than those in Stages 1 and 2 (p<0.05). FES scores positively correlated with age, COPD duration, CAT, mMRC, and TUG; and negatively with FEV₁, FVC, BBS, and 6MWT. All 10 patients with FES ≥70 had moderate fall risk by BBS. Among those with FES ≤70, 22.8% had moderate to high objective fall risk.

FOF in COPD is associated with age, disease duration, symptom severity, balance, and physical capacity. Balance-focused interventions should be integrated into pulmonary rehabilitation.