Clinical Effects of Rehabilitation on Balance in People With Chronic Obstructive Pulmonary Disease: A Systematic Review and Meta-Analysis

Canales-Díaz, María Belén; Olivares-Valenzuela, Carolina; Ramírez-Arriagada, Amanda; Cruz‐Montecinos, Carlos; Vilaró, Jordi; Torres‐Castro, Rodrigo

doi:10.3389/fmed.2022.868316

Cited by 8 publications

(16 citation statements)

References 44 publications

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“…As discussed above, we did not find association between muscle strength and postural sway in quiet stance (UEO), while this was present in limits of stability (LoS AP) test. These results highlight the complexity and variety of the demands on the postural control in different tasks, in line with a recently published review and meta-analysis [ 37 ]. Together, it emphasizes the value for both clinicians and researchers of using several tests for evaluation as well as a diverse intervention for postural control improvements.…”

Section: Discussionsupporting

confidence: 87%

Postural control among individuals with and without chronic obstructive pulmonary disease: A cross-sectional study of motor and sensory systems

et al. 2023

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Background Chronic obstructive pulmonary disease (COPD) is considered a heterogenic syndrome with systemic effects, including muscle dysfunction. There is evidence of postural control impairments among individuals with COPD, partly related to muscle weakness. However, research is scarce regarding the other underlying systems of postural control, such as the visual, somatosensory and vestibular system. The aim was to compare postural control, as well as the motor and sensory systems, between individuals with and without COPD. Methods Twenty-two participants with COPD (mean age 74.0 ±6.2 years) and 34 non-obstructive references (mean age 74.9 ±4.9 years) participated in this cross-sectional study. Postural control was assessed with center of pressure trajectory of postural sway in quiet as well as a limits of stability test, calculating mediolateral and anteroposterior amplitudes for each test. Assessment of function in the motor system included maximum hand grip strength, as well as maximum strength in muscles around the hip, knee and ankle joints. Visual acuity, pressure sensibility, proprioception, vestibular screening, and reaction time were also included. Data was compared between groups, and significant differences in postural control were further analyzed with an orthogonal projection of latent structures regression model. Results There was a significantly increased sway amplitude in the mediolateral direction in quiet stance on soft surface with eyes open (p = 0.014) as well as a smaller anteroposterior amplitude in the limits of stability test (p = 0.019) in the COPD group. Regression models revealed that the mediolateral amplitude was related to visual acuity and the burden of tobacco smoking assessed as pack-years. Further, muscle strength associated with anteroposterior amplitude in limits of stability test in the COPD group, and with age and ankle dorsal flexion strength among the referents. Besides for lower ankle plantar flexion strength in the COPD group, there were however no significant differences in muscle strength. Conclusions Individuals with COPD had a decreased postural control and several factors were associated with the impairments. The findings imply that the burden of tobacco smoking and reduced visual acuity relate to increased postural sway in quiet stance, and that muscle weakness is related to decreased limits of stability, among individuals with COPD.

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Section: Discussionsupporting

confidence: 87%

Postural control among individuals with and without chronic obstructive pulmonary disease: A cross-sectional study of motor and sensory systems

et al. 2023

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“…Future studies could establish whether there is a cut-off threshold to define the risk of falls in this population. In addition, it is important to identify the most vulnerable patients with poorer physical performance and to develop personalised rehabilitation and health promotion strategies [ 16 ].…”

Section: Discussionmentioning

confidence: 99%

“…hip fractures) and are a major cost to health systems worldwide [ 14 , 15 ]. Therefore, close monitoring of balance impairment in people with stable COPD is necessary to provide early rehabilitation to reduce the risk of future falls [ 16 ]. To assess balance impairment in adults with COPD, different clinical tests have been proposed including static and dynamic balance tests [ 17 ].…”

Section: Introductionmentioning

confidence: 99%

Clinical assessment of balance and functional impairments in people with stable chronic obstructive pulmonary disease: a systematic review and meta-analysis

et al. 2022

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The objective of this study is to compare the balance and functional capacity between stable Chronic Obstructive Pulmonary Disease (COPD) patients versus healthy controls using clinical tests. A comprehensive search of PubMed/MEDLINE, the Cochrane Central Register of Controlled Trials (CENTRAL), Embase, and Web of Science was conducted from inception to 21 January 2022. Studies reporting the association between COPD status and balance or functional capacity using clinical tests were included. Two independent reviewers examined the titles and abstracts, extracted the data using a standardised form, and assessed the risk of bias of the included articles. A total of 27 studies with 2420 individuals with stable COPD were included. Overall, the risk of bias in the included studies was low to moderate. The meta-analysis showed a higher history of falls in individuals with COPD (Odds Ratio: 1.59 [95%CI: 1.25–2.02]). Furthermore, an overall effect in favour of the healthy controls was observed in the Timed Up and Go (mean difference: 2.61 s [95%CI: 1.79–3.43]), Berg Balance Scale (mean difference: −6.57 points [95%CI: −8.31 to −4.83]), static balance tests (standardised mean difference: −1.36 [95%CI: −2.10 to −0.62]), and the 6-minute walk test (mean difference: −148.21 meters [95%CI: −219.37 to −77.39]). In conclusion, individuals with stable COPD have worse balance and functional capacity compared to healthy controls. These results may guide clinicians to elaborate on therapeutic strategies focused on screening of balance and functional impairments. This is in addition to generating rehabilitation guidelines aimed at reducing the risk of falling in people with COPD.

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“…Age-related reductions in physiological capacity are most pronounced in respiratory mechanics. Patients with chronic obstructive pulmonary diseases (COPD’s) have balance impairments compared to healthy subjects, which may be related to reduced muscle strength, physical activity and exercise capacity [ 3 , 4 , 5 ] and are four-times more likely to fall than healthy peers, leading to increased morbidity and mortality [ 6 ]. What is more, they also demonstrate scapular control impairments, such as scapular elevation, internal rotation and protraction, which have negative influences on geometrical arrangements of the thorax and scapulae [ 7 ].…”

Section: Introductionmentioning

confidence: 99%

“…Metanalyses show that pulmonary rehabilitation improves static and dynamic balance in patients with COPD, measured by clinical balance tests. Moreover, pulmonary rehabilitation combined with balance training, including strength training, endurance or walking exercises, aquatic exercises, exercises with neuromuscular electrical stimulation and specific balance training, in addition to traditional treatments, showed greater benefits than the conventional treatments based on improving respiratory symptomatology [ 4 , 13 ].…”

Section: Introductionmentioning

confidence: 99%

Dynamic Balance and Chest Mobility of Older Adults after Speleotherapy Combined with Pulmonary Rehabilitation, Endurance and Strength Training—A Prospective Study in Chronic Respiratory Diseases

Mętel

Kostrzon

Adamiak

2022

IJERPH

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Backgrounds: As people age, they are more likely to experience balance disturbances. Pulmonary rehabilitation is recognized as a core component in the management of older adults with chronic respiratory diseases. The aim of the study was to assess the dynamic balance and chest mobility of older adults participating in speleotherapy combined with pulmonary rehabilitation, endurance and strength training. Methods: The study group consisted of 51 older adults with chronic respiratory disorders who participated in a 3-week pulmonary rehabilitation programme in underground salt chambers in the ‘Wieliczka’ Salt Mine Health Resort. These individuals underwent the Four Square Step Test (FSST) and circumferential chest mobility measurement before and after the outpatient rehabilitation programme conducted 135 m underground. Results: Before rehabilitation in the underground salt chambers, half of the results (50%, 22 patients) were below the norm in the assessment of chest mobility between maximal inhale and exhale. The average time needed to perform FSST decreased significantly (p ≤ 0.05) from 10.2 ± 1.9 s before the stay to 9.1 ± 1.7 s after the stay and the average increase in chest mobility increased significantly (p ≤ 0.05) from 4.5 ± 5.5 cm to 5.4 ± 2.8 cm. Conclusions: Speleotherapy combined with pulmonary rehabilitation, endurance and strength training increased the dynamic balance and chest mobility of older adults with chronic respiratory diseases, as measured by the FSST and circumferential chest expansion assessment.

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Clinical Effects of Rehabilitation on Balance in People With Chronic Obstructive Pulmonary Disease: A Systematic Review and Meta-Analysis

Cited by 8 publications

References 44 publications

Postural control among individuals with and without chronic obstructive pulmonary disease: A cross-sectional study of motor and sensory systems

Postural control among individuals with and without chronic obstructive pulmonary disease: A cross-sectional study of motor and sensory systems

Clinical assessment of balance and functional impairments in people with stable chronic obstructive pulmonary disease: a systematic review and meta-analysis

Dynamic Balance and Chest Mobility of Older Adults after Speleotherapy Combined with Pulmonary Rehabilitation, Endurance and Strength Training—A Prospective Study in Chronic Respiratory Diseases

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