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Original Article

Life-Space mobility and clinical outcomes in COPD

Anand S Iyer1 Department of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, AL, USA, [email protected];2 Health Services, Outcomes, and Effectiveness Research Training Program, University of Alabama at Birmingham, Birmingham, AL, USA, [email protected];3 Department of Medicine, Lung Health Center, University of Alabama at Birmingham, Birmingham, AL, USA, [email protected]Correspondence[email protected]

James M Wells1 Department of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, AL, USA, [email protected];3 Department of Medicine, Lung Health Center, University of Alabama at Birmingham, Birmingham, AL, USA, [email protected];4 Veterans Affairs Medical Center, Birmingham, AL, USA

Surya P Bhatt1 Department of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, AL, USA, [email protected];3 Department of Medicine, Lung Health Center, University of Alabama at Birmingham, Birmingham, AL, USA, [email protected]

deNay P Kirkpatrick1 Department of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, AL, USA, [email protected];3 Department of Medicine, Lung Health Center, University of Alabama at Birmingham, Birmingham, AL, USA, [email protected]

Patricia Sawyer5 Department of Medicine, Division of Gerontology, Geriatrics, and Palliative Care, University of Alabama at Birmingham, Birmingham, AL, USA

Cynthia J Brown4 Veterans Affairs Medical Center, Birmingham, AL, USA;5 Department of Medicine, Division of Gerontology, Geriatrics, and Palliative Care, University of Alabama at Birmingham, Birmingham, AL, USA

Richard M Allman6 Department of Medicine, George Washington University School of Medicine, Washington, DC, USA

Marie A Bakitas5 Department of Medicine, Division of Gerontology, Geriatrics, and Palliative Care, University of Alabama at Birmingham, Birmingham, AL, USA;7 Department of Medicine, Center for Palliative and Supportive Care, Division of Geriatrics, Gerontology, and Palliative Care Medicine, University of Alabama at Birmingham, Birmingham, AL, USA;8 School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA

Mark T Dransfield1 Department of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, AL, USA, [email protected];3 Department of Medicine, Lung Health Center, University of Alabama at Birmingham, Birmingham, AL, USA, [email protected];4 Veterans Affairs Medical Center, Birmingham, AL, USA

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Abstract

Background

Social isolation is a common experience in patients with COPD but is not captured by existing patient-reported outcomes, and its association with clinical outcomes is unknown.

Methods

We prospectively enrolled adults with stable COPD who completed the University of Alabama at Birmingham Life Space Assessment (LSA) (range: 0–120, restricted Life-Space mobility: ≤60 and a marker of social isolation in older adults); six-minute walk test (6MWT), and the University of California at San Diego Shortness of Breath Questionnaire, COPD Assessment Test, and Hospital Anxiety and Depression Scale. The occurrence of severe exacerbations (emergency room visit or hospitalization) was recorded by review of the electronic record up to 1 year after enrollment. We determined associations between Life-Space mobility and clinical outcomes using regression analyses.

Results

Fifty subjects had a mean ± SD %-predicted FEV₁ of 42.9±15.5, and 23 (46%) had restricted Life-Space mobility. After adjusting for age, gender, %-predicted FEV₁, comorbidity count, inhaled corticosteroid/long-acting beta₂-agonist use, and prior cardiopulmonary rehabilitation, subjects with restricted Life-Space had an increased risk for severe exacerbations (adjusted incidence rate ratio 4.65, 95% CI 1.19–18.23, P=0.03). LSA scores were associated with 6MWD (R=0.50, P<0.001), dyspnea (R=−0.58, P<0.001), quality of life (R=−0.34, P=0.02), and depressive symptoms (R=−0.39, P=0.005).

Conclusion

Restricted Life-Space mobility predicts severe exacerbations and is associated with reduced exercise tolerance, more severe dyspnea, reduced quality of life, and greater depressive symptoms.

Keywords:

Author contributions

All authors contributed toward data analysis, drafting and revising the paper and agree to be accountable for all aspects of the work.

Disclosure

ASI reports support from UAB Patient Centered Outcomes Research [K12HS023009]. SPB acknowledges support from the NIH [K23HL133438]. JMW acknowledges support from the NIH [K08HL123940]. RMA has no conflicts of interest to report. MAB is supported by NINR 1 R01 [NR013665-01A1]. MTD reports grants from the NIH and Department of Defense, consulting fees from AstraZeneca, Genentech, GlaxoSmithKline, and PneumRx/BTG, and contracted clinical trials from AstraZeneca, Boehringer Ingelheim, GlaxoSmithKline, Novartis, PneumRx/BTG, Pulmonx, and Yungjin. This study was supported in part by a grant from the NIA [R01 AG015062] to CJB. dPK and PS have no conflicts to disclose.

Life-Space mobility and clinical outcomes in COPD

Background

Methods

Results

Conclusion

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Life-Space mobility and clinical outcomes in COPD

Abstract

Background

Methods

Results

Conclusion

Author contributions

Disclosure

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