Assessing postural balance for predicting falls in individuals with Chronic obstructive pulmonary disease: A prospective cohort study

Individuals with severe Chronic Obstructive Pulmonary Disease (COPD) have a higher risk of falls while performing physical activities; however, assessments to distinguish who falls are lacking.

To assess postural balance under challenging conditions to discriminate individuals who experience a fall.

Patients with moderate to very severe COPD were recruited and performed postural balance assessment. The centre of pressure (COP) was measured using a force platform under different conditions: at rest, post-effort, semi-tandem, and semi-tandem+post-effort. Individuals received a fall diary and were monitored during six months by phone calls. After the follow-up period, patients who experienced a fall were included in the Falls Group (FG) and those who did not were included in the Non-Falls Group (NFG). Receiver operating characteristic (ROC) curves were constructed, and the area under the curve (AUCs) was calculated to assess the predictive value of postural strategies.

Individuals with COPD (n = 61); FG (n = 26) and NFG (n = 35) were included. Compared with NFG, FG presented greater path length (42.5 [34.1, 54.7] vs. 34.1 [29.2, 42.5]cm) and COP-AP (2.60 [2.10, 3.50] vs. 2.10 [1.70, 2.60]cm) in post-effort position. In the semi-tandem position, FG presented greater COP-ML than NFG (3.00 [2.50, 4.00] vs. 2.50 [2.20, 3.00]cm). FG also presented a greater path length (82.1 [67.4, 136.9] vs. 67.4 [56.3, 82.1]cm), COP-ML (3.70 [2.90, 5.50] vs. 2.90 [2.10, 3.70]cm), and COP-AP (3.80 [3.10, 5.00] vs. 3.10 [2.10, 3.80]cm) than NFG did in semi-tandem post-effort position. In total, 100 falls were reported, most of which occurred inside the patient's home (65 %) and while individuals were walking (48 %).

Assessing postural balance in challenging positions can discriminate between individuals with severe COPD who experience a fall.