The Investigation of Falls and Balance from the Perspective of Activities of Daily Living in Patients with COPD

Figures & data

Figure 1. Design of the study.

Table 1. Demographic and clinical characteristics of groups.

	Fallers	Non-fallers
	(n = 14)	(n = 14)	P
Age, years	71.14 ± 11.80 [65.07 to 77.85]	69.14 ± 7.29 [65.28 to 73.00]	0.54
Sex^a
Female	5 (35.7%)	5 (35.7%)	1.00
Male	9 (64.2%)	9 (64.2%)
BMI, kg/m^−2	28.71 ± 4.72 [26.41 to 30.99]	28.25 ± 2.34 [27.06 to 29.45]	0.76
Smoking status^a
Non-smoker	3 (21.4%)	2 (14.3%)	0.83
Ex-smoker	9 (64.3%)	10 (71.4%)
Current smoker	2 (14.3%)	2 (14.3%)
Pack years of smoking history	46.17 ± 28.16 [31.20–61.14]	45.95 ± 30.67 [30.36–66.56]	0.99
Charlson comorbidity index	5.07 ± 1.59 [4.21 to 5.85]	4.15 ± 1.40 [3.44 to 4.87]	0.11
MMRC, score	Median 1.5, IQR 2	Median 1, IQR 1	0.19
CAT, score	15.35 ± 4.65 [13.21 to 17.71]	9.15 ± 4.35 [7.28 to 11.02]	0.001^b
Combined assessment of COPD^a
GOLD A	3 (21.4%)	8 (57.1%)
GOLD B	7 (50%)	4 (28.6%)	0.16
GOLD C	2 (14.3%)	2 (14.3%)
GOLD D	2 (14.3%)	0 (0%)
FEV1 ,% pred	61.57 ± 19.18 [51.85 to 70.71]	65.24 ± 18.61 [55.71 to 74.77]	0.14
FEV1/FVC, %	61.17 ± 7.45 [57.06 to 64.53]	61.62 ± 6.96 [57.86 to 65.38]	0.58
LCADL scale, score	17.78 ± 8.72 [13.64 to 22.42]	10.24 ± 7.60 [6.35 to 14.14]	0.02^b
LCADL scale, %total	23.71 ± 11.63 [18.28–29.90]	13.42 ± 10.36 [8.38–18.75]	0.02^b
ABC scale, score	68.43 ± 14.28 [60.75 to 75.93]	84.58 ± 8.19 [80.02 to 89.15]	0.001^b
BBS, score	42.92 ± 10.09 [37.50 to 47.71]	51.98 ± 2.90 [50.28 to 53.68]	0.004^b
6MWD, metre	298.71 ± 32.72 [224.80 to 362.71]	364.08 ± 47.14 [343.64 to 384.52]	0.08
Δ Dyspnoea 6MWT, score	3.00 ± 1.35 [2.35–3.71]	2.00 ± 0.62 [1.71–2.30]	0.06
Δ Fatigue 6MWT, score	3.14 ± 1.65 [2.35–4.07]	2.17 ± 0.80 [1.78–2.56]	0.13
Muscle strength of QF, N kg^−1
Dominant side	9.47 ± 3.04 [8.29 to 11.29]	9.72 ± 1.41 [9.02 to 10.42]	0.79
Non-dominant side	8.86 ± 2.52 [7.75 to 10.37]	9.78 ± 1.26 [8.94 to 10.63]	0.34

6MWD: six-minute walking distance; 6MWT: six-minute walking test; ABC: activities-specific balance confidence; BBS: berg balance scale; BMI: body mass index; CAT: COPD assessment test; COPD: chronic obstructive pulmonary disease; FEV₁: forced expiratory volume in 1 s; FVC: forced vital capacity; GOLD: the global initiative for chronic obstructive lung disease; IQR: interquartile range; LCADL: London chest activity of daily living.

Δ: after-before 6MWT.

Data are expressed as mean ± SD [95% Confidence Interval] or n (%).

^aChi square test; the significance was accepted as p < 0.05.

^bIndependent samples t-test; the significance was accepted as p < 0.05.

Table 2. Comparison of the LCADL scale item scores between groups.

	Fallers	Non-fallers
	(n = 14)	(n = 14)	P^a
Self-care
Item 1: Drying	1.28 ± 1.20	0.64 ± 0.55	0.08
Perceived risk of falling during the activity	0.65 ± 0.50	0.26 ± 0.07	0.03
Item 2: Dressing the upper body	1.00 ± 0.96	0.75 ± 0.42	0.07
Perceived risk of falling during the activity	0.97 ± 0.78	0.26 ± 0.07	0.005
Item 3: Putting shoes/socks on	1.85 ± 1.46	1.25 ± 0.91	0.08
Perceived risk of falling during the activity	1.06 ± 0.71	1.08 ± 0.35	0.06
Item 4: Washing hair	0.89 ± 0.78	0.42 ± 0.21	0.04
Perceived risk of falling during the activity	0.64 ± 0.42	1.08 ± 0.35	0.01
Domestic
Item 5: Making beds	0.85 ± 0.57	0.75 ± 0.50	0.81
Perceived risk of falling during the activity	0.54 ± 0.42	0.26 ± 0.07	0.06
Item 6: Changing sheets	0.74 ± 0.64	0.64 ± 0.32	0.28
Perceived risk of falling during the activity	0.64 ± 0.42	0.26 ± 0.07	0.06
Item 7: Wash windows/curtains	0.80 ± 0.78	1.06 ± 0.71	0.57
Perceived risk of falling during the activity	0.65 ± 0.50	0.26 ± 0.07	0.03
Item 8: Cleaning/dusting	0.60 ± 0.33	0.58 ± 0.34	0.57
Perceived risk of falling during the activity	0.64 ± 0.42	0.26 ± 0.07	0.06
Item 9: Washing up	0.57 ± 0.54	0.46 ± 0.28	0.21
Perceived risk of falling during the activity	0.64 ± 0.42	0.00 ± 0.00	0.01
Item 10: Vacuuming/sweeping	0.72 ± 0.51	0.72 ± 0.62	0.76
Perceived risk of falling during the activity	0.64 ± 0.42	0.36 ± 0.14	0.18
Physical
Item 11: Walking upstairs	2.42 ± 1.08	2.08 ± 0.82	0.30
Perceived risk of falling during the activity	2.00 ± 1.03	1.07 ± 0.99	0.02
Item 12: Bending	2.21 ± 1.36	1.38 ± 1.30	0.06
Perceived risk of falling during the activity	1.85 ± 1.23	1.20 ± 0.92	0.04
Leisure
Item 13: Walking in the home	1.14 ± 0.77	0.71 ± 0.72	0.14
Perceived risk of falling during the activity	1.35 ± 1.08	0.51 ± 0.50	0.02
Item 14: Going out socially	1.64 ± 1.21	0.96 ± 0.74	0.12
Perceived risk of falling during the activity	1.64 ± 1.15	0.64 ± 0.42	0.005
Item 15: Talking	0.92 ± 0.61	0.42 ± 0.51	0.03
Perceived risk of falling during the activity	0.46 ± 0.28	0.00 ± 0.00	0.03

LCADL: London chest activity of daily living.

Data are expressed as mean ± SD.

^a Mann-Whitney U test; the significance was accepted as p = 0.05/15 = 0.0033 after Bonferroni correction.

Table 3. Comparison of the ABC scale item scores between groups.

	Fallers	Non-fallers
	(n = 14)	(n = 14)	P
Item 1: Walking around the house	83.57 ± 14.46	93.56 ± 9.18	0.03
Item 2: Up and downstairs	72.85 ± 17.28	80.41 ± 13.48	0.15
Item 3: Pick up slippers from the floor	67.85 ± 22.93	85.25 ± 12.40	0.01
Item 4: Reaching at eye level	79.28 ± 15.91	90.01 ± 8.21	0.02
Item 5: Reaching on tiptoes	73.57 ± 15.98	88.98 ± 11.51	0.006
Item 6: Standing on the chair to reach	54.28 ± 19.88	75.42 ± 24.32	0.01
Item 7: Sweeping the floor	77.14 ± 16.37	78.18 ± 20.98	0.77
Item 8: Walk outside to the nearby car	75.00 ± 17.43	89.35 ± 8.27	0.005
Item 9: Getting in/out of cars	71.42 ± 17.03	90.00 ± 7.82	0.001^a
Item 10: Walk across the car park	73.57 ± 16.45	86.85 ± 11.36	0.01
Item 11: Up and down slopes	60.00 ± 17.09	83.49 ± 10.09	0.001^a
Item 12: Walk in crowded mall	64.28 ± 16.50	87.82 ± 10.04	0.001^a
Item 13: Walk in crowded mall/bumped	62.85 ± 20.54	84.42 ± 12.31	0.002^a
Item 14: Escalator holding rail	65.71 ± 17.85	87.41 ± 10.10	0.001^a
Item 15: Escalator not holding the rail	57.85 ± 18.05	81.41 ± 12.32	0.001^a
Item 16: Walk on the icy sidewalk	52.14 ± 19.28	68.28 ± 14.61	0.01

ABC: activities-specific balance confidence.

Data are expressed as mean ± SD or n (%).

^aIndependent samples t-test; the significance was accepted as p = 0.05/16 = 0.0031 after Bonferroni correction.

Table 4. Partial correlation between the LCADL scale item scores, LCADL total score and the ABC scale score and BBS score.

	Fallers		Non-fallers		Total
	(n = 14)		(n = 14)		(n = 28)
	ABC	BBS	ABC	BBS	ABC	BBS
	rho (p)	rho (p)	rho (p)	rho (p)	rho (p)	rho (p)
Self-care
Item 1: Drying	−0.11 (0.72)	−0.45 (0.14)	−0.27 (0.38)	−0.31 (0.32)	−0.38 (0.05)	−0.44 (0.02)
Item 2: Dressing upper body	−0.33 (0.29)	−0.81 (0.001)^a	−0.15 (0.63)	−0.10 (0.73)	−0.36 (0.06)	−0.67 (0.001)^a
Item 3: Putting shoes/socks on	−0.47 (0.11)	−0.54 (0.07)	−0.36 (0.23)	−0.09 (0.77)	−0.48 (0.01)	−0.51 (0.007)^a
Item 4: Washing hair	−0.14 (0.64)	−0.54 (0.06)	−0.26 (0.40)	−0.29 (0.35)	−0.35 (0.07)	−0.58 (0.002)^a
Domestic
Item 5: Making beds	−0.21 (0.49)	−0.44 (0.15)	−0.53 (0.07)	−0.36 (0.23)	−0.30 (0.13)	−0.30 (0.12)
Item 6: Changing sheet	−0.25 (0.42)	−0.53 (0.07)	−0.44 (0.14)	−0.07 (0.82)	−0.36 (0.06)	−0.48 (0.01)^a
Item 7: Washing windows/curtains	0.56 (0.05)	0.35 (0.25)	−0.42 (0.16)	−0.25 (0.42)	−0.06 (0.77)	0.03 (0.86)
Item 8: Cleaning/dusting	−0.08 (0.98)	−0.06 (0.83)	−0.40 (0.19)	−0.01 (0.96)	−0.12 (0.55)	−0.12 (0.54)
Item 9: Washing up	−0.01 (0.96)	−0.23 (0.45)	−0.57 (0.05)	−0.10 (0.75)	−0.25 (0.20)	−0.34 (0.08)
Item 10: Vacuuming/sweeping	0.17 (0.58)	−0.18 (0.56)	−0.25 (0.43)	−0.11 (0.72)	0.01 (0.99)	−0.18 (0.36)
Physical
Item 11: Walking up stairs	−0.34 (0.27)	−0.61 (0.03)	−0.50 (0.09)	−0.73 (0.007)	−0.44 (0.02)	−0.58 (0.002)^a
Item 12: Bending	−0.31 (0.31)	−0.22 (0.48)	−0.31 (0.31)	0.08 (0.79)	−0.38 (0.05)	−0.29 (0.14)
Leisure
Item 13: Walking in the home	−0.54 (0.06)	−0.65 (0.02)	−0.13 (0.68)	0.12 (0.69)	−0.47 (0.01)	−0.49 (0.01)
Item 14: Going out socially	−0.66 (0.01)	−0.51 (0.08)	−0.17 (0.59)	0.44 (0.14)	−0.61 (0.001)^a	−0.46 (0.01)
Item 15: Talking	−0.15 (0.63)	−0.39 (0.20)	−0.03 (0.92)	0.12 (0.70)	−0.32 (0.10)	−0.36 (0.07)
Total score	−0.39 (0.20)	−0.65 (0.02)	−0.43 (0.15)	−0.15 (0.62)	−0.51 (0.007)	−0.57 (0.002)^a

ABC: activities-specific balance confidence; BBS: Berg balance scale; LCADL: London chest activity of daily living.

^aPartial Spearman correlation test, adjusting for Charlson comorbidity index and the isometric muscle strength of the quadriceps femoris; the significance was accepted as p = 0.05/16 = 0.0031 after Bonferroni correction.

Table

	0) Wouldn't do anyway	1) I do not get breathless	2) I get moderately breathless	3) I get very breathless	4) I can't do this anymore	5) Someone else does it for me	Perceived risk of falling for each item
							1. Very low	2. Low	3. Moderate	4. High	5. Very high
SELF CARE
1. Drying	0	1	2	3	4	5	1	2	3	4	5
2. Dressing upper body	0	1	2	3	4	5	1	2	3	4	5
3. Putting shoes/socks on	0	1	2	3	4	5	1	2	3	4	5
4. Washing hair	0	1	2	3	4	5	1	2	3	4	5
DOMESTIC
1. Make beds	0	1	2	3	4	5	1	2	3	4	5
2. Change sheet	0	1	2	3	4	5	1	2	3	4	5
3. Wash windows/curtains	0	1	2	3	4	5	1	2	3	4	5
4. Clean/dusting	0	1	2	3	4	5	1	2	3	4	5
5. Wash up	0	1	2	3	4	5	1	2	3	4	5
6. Vacuuming/sweeping	0	1	2	3	4	5	1	2	3	4	5
PHYSICAL
1. Walking up stairs	0	1	2	3	4	5	1	2	3	4	5
2. Bending	0	1	2	3	4	5	1	2	3	4	5
LEISURE
1. Walking in home	0	1	2	3	4	5	1	2	3	4	5
2. Going out socially	0	1	2	3	4	5	1	2	3	4	5
3. Talking	0	1	2	3	4	5	1	2	3	4	5