Postural control in chronic obstructive pulmonary disease: a systematic review

Figures & data

Table 1 Characterization of studies included in the final analysis

Reference	PEDro score	Setting	Study design	Keywords	Outcome variables	COPD/controls (n)	Assessment method
Rocco et al^Citation13	9	São Paulo (Brazil)	Cross-sectional	Balance, COPD	Dynamic balance, monosynaptic reflexes, peripheral muscle strength, SST	22/16	Tinetti test, strength platform
Butcher et al^Citation12	8	Saskatoon (Canada)	Cross-sectional	COPD, disease severity, balance assessment, functional effects	Balance, coordination and mobility	15/15/21	TUG test, fast gait speed test, posturography, and finger-to-nose and toe-tapping coordination tests
Smith et al^Citation20	8	Queensland (Australia)	Cross-sectional	Postural control, COPD, balance, exercise, respiratory conditions	Postural control, lumbar spine and hip motion	12/12	Force plate to record center of pressure displacement, inclinometers
Beauchamp et al^Citation9	8	Toronto (Canada)	Cross-sectional	Fall, COPD, balance, rehabilitation	Postural control, risk of fall, skill, incidence of falls, exercise tolerance	39	TUG, BBS, 6MWT, ABC, MRC
Beauchamp et al^Citation15	6	Toronto (Canada)	Prospective	Accidental falls, postural balance, COPD, rehabilitation	Postural control, tolerance exercise	38	CRQ
Beauchamp et al^Citation17	7	Toronto (Canada)	Cross-sectional	–	Balance, physical activity and lower extremity muscle strength	37/20	Best test, physical activity scale for the elderly, isokinetic dynamometer
Janssens et al^Citation21	7	Leuven (Belgium)	Cross-sectional	–	Postural control, ankle and back muscle vibration, inspiratory muscle strength	18/18

Abbreviations: SST, sit-to-stand test; TUG,Timed Up and Go; BBS, Berg Balance Scale; ABC, Activities-specific Balance Confidence; MRC, Medical Research Council dyspnea score; 6MWT, Six-minute walking test; CRQ, Chronic Respiratory Questionnaire; COPD, chronic obstructive pulmonary disease.

Figure 1 Flow diagram of manuscript selection procedure.

Table 2 Study identification and sample characterization

Reference	Age (years)	FEV1 (%)	Falls (%)	Impaired postural control correlations
Rocco et al^Citation13	70±6.66	39.88±8.69	–	BODE index
Butcher et al^Citation12	69.5±8.5	29.87±3.73	–	Disease severity, activity levels
Smith et al^Citation20	64.6 (53–80)	33.1±12.7	–	Increased trunk muscle activity and compromised postural control
Beauchamp et al^Citation9	71.1±6.8	41.5±17	46	Need for supplementary oxygen in patients
Beauchamp et al^Citation15	69.8±10.3	46.3±22.3	41	Change in physical capacity (6MWT) or dyspnea scores (CRQ)
Beauchamp et al^Citation17	71±7	39.4±16.3	51	Low self-reported physical activity levels and lower extremity muscle weakness
Janssens et al^Citation21	64±7	50±18	–	Inspiratory muscle weakness and proprioceptive dysfunction

Abbreviations: FEV₁, forced expiratory volume in first second; BODE, Body-mass index, airflow Obstruction, Dyspnea, and Exercise; 6MWT, Six-minute walking test; CRQ, Chronic Respiratory Questionnaire.

Table 3 Outcomes reported by the included studies

Reference	BBS control	BESTest (score)	ABC (score)	TUG test	Other	Conclusion
Rocco et al^Citation13	–	–	–	–	26.86/27.81 (P<0.05)	COPD patients had functional and neurophysiological alterations in comparison with controls
Butcher et al^Citation12	–	–	–	7.2/5.35 (P<0.05)	–	COPD exhibit deficiencies in functional balance, coordination, and mobility tasks
Smith et al^Citation20	–	–	–	–	–	There is reduced control of balance in the mediolateral direction and increased risk of falls in COPD patients
Beauchamp et al^Citation9	45.2/48.8 (P<0.042)	–	65.8/81.7 (P<0.002)	17/14 (P<0.024)	–	There are differences in balance, functional mobility, and balance confidence between fallers and nonfallers in patients with COPD
Beauchamp et al^Citation15	46.9	–	74.3	15.7	–	PR was associated with minor changes in results of standard clinical tests of balance and had no effect on balance confidence in patients with COPD
Beauchamp et al^Citation17	48.7/54.9 (P<0.001)	70.7/91.9 (P<0.001)	75.8/95.8 (P<0.001)	–	–	Impaired balance in COPD, deficiencies in balance associated with low self–reported physical activity levels and lower extremity muscle weakness
Janssens et al^Citation21	–	–	–	–	–	Patients with COPD, especially those with inspiratory muscle weakness, increased their reliance on ankle muscle proprioceptive signals and decreased their reliance on back muscle proprioceptive signals during balance control

Abbreviations: PR, pulmonary rehabilitation; COPD, chronic obstructive pulmonary disease; BBS, Berg Balance Scale; TUG, Timed Up and Go; ABC, Activities-specific Balance Confidence; BESTest, Balance Evaluation Systems Test.

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