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

Rodrigo Núñez-Cortés, Paloma Padilla-Acevedo, Franchesca Vergara-Peña, Sara Mollà-Casanova, Claudia Espinoza-Bravo, Rodrigo Torres-Castro, Carlos Cruz-Montecinos
ERJ Open Research 2022 8: 00164-2022; DOI: 10.1183/23120541.00164-2022
Rodrigo Núñez-Cortés
1Department of Physical Therapy, Faculty of Medicine, University of Chile, Santiago, Chile
2Physiotherapy in Motion Multispeciality Research Group (PTinMOTION), Department of Physiotherapy, University of Valencia, València, Spain
3International Physiotherapy Research Network (PhysioEvidence), Barcelona, Spain
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  • ORCID record for Rodrigo Núñez-Cortés
  • For correspondence: r_nunez@uchile.cl
Paloma Padilla-Acevedo
1Department of Physical Therapy, Faculty of Medicine, University of Chile, Santiago, Chile
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Franchesca Vergara-Peña
1Department of Physical Therapy, Faculty of Medicine, University of Chile, Santiago, Chile
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Sara Mollà-Casanova
4UBIC, Departament de Fisioteràpia, Universitat de València, València, Spain
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Claudia Espinoza-Bravo
5Day Hospital Unit, Hospital Clínico la Florida, Santiago, Chile
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Rodrigo Torres-Castro
1Department of Physical Therapy, Faculty of Medicine, University of Chile, Santiago, Chile
3International Physiotherapy Research Network (PhysioEvidence), Barcelona, Spain
6Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
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Carlos Cruz-Montecinos
1Department of Physical Therapy, Faculty of Medicine, University of Chile, Santiago, Chile
2Physiotherapy in Motion Multispeciality Research Group (PTinMOTION), Department of Physiotherapy, University of Valencia, València, Spain
7Section of Research, Innovation and Development in Kinesiology, Kinesiology Unit, San José Hospital, Santiago, Chile
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  • FIGURE 1
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    FIGURE 1

    Study selection process.

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    FIGURE 2

    Summary of risk of bias assessment using the Quality in Prognosis Studies (QUIPS) tool.

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    FIGURE 3

    Quantitative synthesis. a) Forest plot of the comparison of history of previous falls between people with COPD and healthy controls; b) forest plot of the comparison of Timed Up and GO (TUG) between people with COPD and healthy controls; c) forest plot of the comparison of Berg Balance Scale (BBS) between people with COPD and healthy controls; d) forest plot of the comparison of balance static tests between people with COPD and healthy controls; e) forest plot of the comparison of 6MWT between people with COPD and healthy controls. Each study considered in the meta-analysis corresponds to a point estimate, which is bounded by a 95% CI. The polygon at the bottom of the graph corresponds to the summary effect, and its width represents its 95% CI. OR: odds ratio; 95% CI: 95% confidence interval; COPD: chronic obstructive pulmonary disease; MD: mean difference; SMD: standardised mean difference; 6MWT: 6-min walk test.

Tables

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  • TABLE 1

    Characteristics of the included studies

    Study, year (country)Study designn (M/F)Age yearsBMI kg·m−2FEV1 % predictedOutcome
    Butcher et al., 2004 (Canada)Cross-sectionalCOPD (NO): 15 (7/8)
    COPD (WO): 15 (5/10)
    Control: 21 (3/18)
    COPD (NO): 72±2
    COPD (WO): 69±2
    Control: 68±1
    NRCOPD (NO): 45±3
    COPD (WO): 29±3
    Control: 105±3
    TUG
    Hernandes et al., 2009 (Brazil)Cross-sectionalCOPD: 40 (18/22)
    Control: 30 (14/6)
    COPD: 66±8
    Control: 64±7
    COPD: 27±6
    Control: 28±4
    COPD: 46±16
    Control: 111±20
    6MWT
    Ozalevli et al., 2010 (Turkey)Cross-sectionalCOPD: 36 (25/11)
    Control: 20 (13/7)
    COPD: 70.3±3
    Control: 68.5±7.3
    COPD: 24.6±5
    Control: 27.6±2.6
    COPD: 43.5±6
    Control: 98.3±11.1
    BBS, 6MWT
    Corrêa et al., 2011 (Brazil)Cross-sectionalCOPD: 10 (3/7)
    Control: 10 (3/7)
    COPD: 64±10
    Control: 63±7
    COPD: 23±5
    Control: 24±3
    COPD: 38±11
    Control: 95±18
    6MWT
    Roig et al., 2011 (Canada)Cross-sectionalCOPD: 21 (NR/NR)
    Control: 21 (NR/NR)
    COPD: 71.2±8.1
    Control: 67.4±7.6
    COPD: 25.6±4.2
    Control: 25.3±4
    COPD: 47.2±12.9
    Control: 98.1±11.9
    6MWT
    Ilgin et al., 2011 (Turkey)Cross-sectionalCOPD: 511 (NR/NR)
    Control: 113 (NR/NR)
    GOLD I: 63.7±10.6
    GOLD II: 67.1±9.5
    GOLD III 66.0±9.8
    GOLD IV 62.7±8.6
    Control: 61.7±9.9
    GOLD I: 25.7±3.8
    GOLD II: 25.6±3.9
    GOLD III: 25.4±4.6
    GOLD IV 25.3±5.0
    Control: 27.2±4.2
    GOLD I: 90.0±8.4
    GOLD II: 64.0±8.3
    GOLD III 39.5±5.8
    GOLD IV: 25.0±3.2
    Control: 99.3±16.9
    6MWT
    Beauchamp et al., 2012 (Canada)Cross-sectionalCOPD: 37 (17/20)
    Control: 20 (8/12)
    COPD: 71±7
    Control: 67±9
    COPD: 28.9±10.5
    Control: 24.8±3.4
    COPD: 39.4±16.3
    Control: 96.9±15.9
    BESTest, BBS, ABC
    Annegarn et al., 2012 (Netherlands)Cross-sectionalCOPD: 79 (47/32)
    Control: 24 (15/9)
    COPD: 64.3±8.9
    Control: 63.7±5.9
    COPD: 24.7±4.5
    Control: 25.8±3.8
    COPD: 53.5±18.7
    Control: 124.9±21.0
    6MWT
    Chien et al., 2013 (China)Cross-sectionalModerate COPD: 40 (37/7)
    Severe COPD: 48 (30/10)
    Control: 14 (12/2)
    COPD:
    moderate/severe
    67±1/69±1
    Control: 62±2
    Moderate COPD: 24.3±0.6
    Severe COPD: 22.2±0.6
    Control: 23±1
    Moderate COPD: 67±1
    Severe COPD: 35±1
    Control: 92±2
    6MWT
    Amorin et al., 2014 (Brazil)Cross-sectionalCOPD: 40 (22/18)
    Control: 20 (19/21)
    COPD: 64±7
    Control: 66±10
    COPD: 25±3
    Control: 25±3
    COPD: 47±15
    Control: 109±13
    6MWT
    Mkacher et al., 2014 (Tunisia)ProspectiveCOPD: 16 (16/0)
    Control: 18 (18/0)
    COPD: 56.22±4.12
    Control 58.06±2.91
    COPD: 26.47±1.78
    Control 26.16±1.59
    COPD: 49.75±2.56
    Control 90.27±5.76
    TUG, SLS, BBS
    Crisan et al., 2015 (Romania)Cross-sectionalCOPD: 29 (NR/NR)
    Control: 17 (NR/NR)
    COPD: 62.2±5.0
    Control: 61.4±4.0
    COPD: 25.4±3.6
    Control: 25.3±3.9
    COPD: 29±7
    Control: 95±18
    BBS, SLS, TUG
    Oliveira et al., 2015 (Australia)Cross-sectionalCOPD: 40 (19/21)
    Control: 25 (12/13)
    COPD: 71±8
    Control: 69±8
    COPD: 25.0±4.8
    Control: 24.6±3.4
    COPD: 45.1±16.2
    Control: 102.1±12.8
    FOF, FES-I, BBS, 6MWT
    Tudorache et al., 2015 (Rumania)Cross-sectionalCOPD: 22 (NR/NR)

    Control: 20 (NR/NR)
    COPD: 63±5

    Control: 63±4
    COPD: 24.2±5.7
    Control: 24.9±3.8
    COPD: 27.5±7
    Control:100.5±12
    FES-I, BBS, TUG, SLS, 6MWT
    Iwakura et al., 2016 (Japan)Cross-sectionalCOPD: 22 (H)
    Control: 13 (H)
    COPD: 71.6±6.9
    Control: 71.5±5.6
    COPD: 22.1±2.9
    Control: 22.7±2.5
    COPD: 52.8±20.6
    Control: 94.7±26.7
    SLS, 6MWT
    Voica et al., 2016 (Romania)Cross-sectionalCOPD: 27 (NR/NR)
    Control: 17 (NR/NR)
    Emphysematous COPD: 64.1±2.6
    Bronchitic COPD: 63.9±1.9
    Control: 61.3±4.0
    Emphysematous COPD: 17.6±0.8
    Bronchitic COPD: 36.1±3.3
    Control: 25.3±3.9
    Emphysematous COPD: 31±2
    Bronchitic COPD: 30±4
    Control: 95±18
    TUG, SLS, BBS, 6MWT
    Albarrati et al., 2016 (UK)Cross-sectionalCOPD: 520 (270/250)
    Control: 150 (76/74)
    COPD: 66.1±7.6
    Control: 65±7.4
    COPD: 28.0±5.5
    Control: 28.1±4.1
    COPD: 58±19
    Control: 105±14
    6MWT, TUG
    Alhaddad et al., 2016 (UK)Cross-sectionalCOPD: 119 (74/45)
    Control: 58 (38/20)
    COPD: 68±8
    Control: 66±9
    COPD: 27.3±6
    Control: 28.6±5.2
    COPD: 59±18
    Control: 100±15
    TUG, 6MWT
    Decastro et al., 2016 (Brazil)Cross-sectionalCOPD: 47 (27/20)
    Control: 25 (15/10)
    COPD: 68±5

    Control: 66±8
    COPD: 26±5
    Control: 28±5
    COPD: 45±15
    Control: 87±17
    TUG, 6MWT
    Oliveira et al., 2017 (Australia)ProspectiveCOPD: 26 (13/13)
    Control: 25 (12/13)
    COPD: 70±9
    Control: 70±8
    COPD: 25±7
    Control: 24±3
    COPD: 44±18
    Control: 102±12
    BBS
    Porto et al., 2017 (Brazil)Cross-sectionalCOPD: 93 (61%/39%)
    Control: 39 (41%/59%)
    COPD: 67.3±10.8
    Control: 65.1±9.7
    NRCOPD: 50.4±19
    Control: 89.2±23.6
    BBS, FES-I
    Iwakura et al., 2019 (Japan)Cross-sectionalCOPD: 34 (34/0)
    Control: 16 (16/0)
    COPD: 71±8
    Control: 72±6
    COPD: 21.8±2.8
    Control: 22.8±2.3
    COPD: 57± 28
    Control:102±19
    6MWT
    Serrão et al., 2020 (Brazil)Cross-sectionalCOPD: 54 (43/10)
    Control: 20 (17/3)
    COPD: 66±8
    Control: 65±8
    COPD: 24±4
    Control: 25±3
    COPD: 34±9
    Control: 101±16
    6MWT
    Gore et al., 2021 (USA)Cross-sectionalCOPD: 382 (43.5%/56.5%)
    Control: 382 (41.5%/58.4%)
    COPD: 74.94±6.75
    Control: 75.23±6.92
    COPD: 29.94±6.69
    Control: 30.39±5.34
    NRTandem posture
    Jirange et al., 2021 (India)Cross-sectionalCOPD: 42
    Control: 45
    COPD: 61.9±4.61
    Control: 60.47±6.18
    COPD: 22.22±3.31
    Control: 23.50±3.27
    COPD: 37.3±7.99
    Control: NR
    TUG
    Ozsoy et al., 2021 (Turkey)Cross-sectionalCOPD: 35 (89.2%/10.8%)
    Control: 27 (84%/16%)
    COPD: 62.13±8.17
    Control: 60.60±7.84
    COPD: 27.95±4.72
    Control: 29.07±3.25
    COPD: 59.18±15.32
    Control: NR
    TUG
    Schons et al., 2021 (Brazil)Case–control studyCOPD: 20 (9/11)
    Control: 16 (7/9)
    COPD: 62.95±8.06
    Control: 59.94±6.43
    COPD: 68.80±14.92
    Control: 68.06±16.11
    COPD: 39.98±11.69
    Control: 97.44±14.45
    6MWT, SLS, TUG

    Data presented as mean±sd unless stated otherwise. Abbreviations: M: male; F: female; BMI: body mass index; FEV1: forced expiratory volume in 1 s; COPD: chronic obstructive pulmonary disease; COPD (NO): no supplemental oxygen; COPD (WO): COPD with supplemental oxygen; NR: not reported; TUG: Timed Up and Go; 6 MWT: 6-min walk test; BBS: Berg Balance Scale; GOLD: Global Initiative for Chronic Obstructive Lung Disease; BESTest: Balance Evaluation Systems Test; ABC: activity-specific balance of confidence scale; SLS: single leg stance; FES-I: Falls Efficacy Scale - International.

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    Clinical assessment of balance and functional impairments in people with stable chronic obstructive pulmonary disease: a systematic review and meta-analysis
    Rodrigo Núñez-Cortés, Paloma Padilla-Acevedo, Franchesca Vergara-Peña, Sara Mollà-Casanova, Claudia Espinoza-Bravo, Rodrigo Torres-Castro, Carlos Cruz-Montecinos
    ERJ Open Research Oct 2022, 8 (4) 00164-2022; DOI: 10.1183/23120541.00164-2022

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    Clinical assessment of balance and functional impairments in people with stable chronic obstructive pulmonary disease: a systematic review and meta-analysis
    Rodrigo Núñez-Cortés, Paloma Padilla-Acevedo, Franchesca Vergara-Peña, Sara Mollà-Casanova, Claudia Espinoza-Bravo, Rodrigo Torres-Castro, Carlos Cruz-Montecinos
    ERJ Open Research Oct 2022, 8 (4) 00164-2022; DOI: 10.1183/23120541.00164-2022
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