Pulmonary rehabilitation with balance training for fall reduction in chronic obstructive pulmonary disease: a randomized controlled trial

Qiukui Hao; Dina Brooks; Cindy Ellerton; Roger Goldstein; Annemarie L Lee; Jennifer A Alison; Gail Dechman; Kimberley J Haines; Samantha L Harrison; Anne E Holland; Alda Marques; Lissa Spencer; Michael K Stickland; Elizabeth H Skinner; Pat G Camp; Jinhui Ma; Marla K Beauchamp

doi:10.1186/s12890-024-03215-2

Pulmonary rehabilitation with balance training for fall reduction in chronic obstructive pulmonary disease: a randomized controlled trial

BMC Pulm Med. 2024 Aug 24;24(1):408. doi: 10.1186/s12890-024-03215-2.

Authors

Qiukui Hao¹, Dina Brooks^{1

2

3

4

5}, Cindy Ellerton^{2

3}, Roger Goldstein^{2

3

4

5}, Annemarie L Lee^{6

7}, Jennifer A Alison^{8

9}, Gail Dechman¹⁰, Kimberley J Haines¹¹, Samantha L Harrison¹², Anne E Holland^{6

13

14}, Alda Marques¹⁵, Lissa Spencer^{8

16}, Michael K Stickland^{17

18}, Elizabeth H Skinner^{7

11}, Pat G Camp^{19

20}, Jinhui Ma²¹, Marla K Beauchamp^{22

23}

Affiliations

¹ School of Rehabilitation Science, Faculty of Health Science, McMaster University, IAHS, 1400 Main St. W, Hamilton, ON, L8S 1C7, Canada.
² Department of Respiratory Medicine, West Park Healthcare Centre, Toronto, ON, Canada.
³ Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
⁴ Rehabilitation Sciences Institute, School of Graduate Studies, University of Toronto, Toronto, ON, Canada.
⁵ Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
⁶ Institute for Breathing and Sleep, Melbourne, VIC, Australia.
⁷ Department of Physiotherapy, School of Primary and Allied Health Care, Monash University, Melbourne, VIC, Australia.
⁸ School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia.
⁹ Allied Health, Sydney Local Health District, Sydney, Australia.
¹⁰ School of Physiotherapy, Faculty of Health, Dalhousie University, Halifax, NS, Canada.
¹¹ Physiotherapy Department, Western Health, Department of Critical Care, The University of Melbourne, Melbourne, VIC, Australia.
¹² School of Health and Life Sciences, Teesside University, Middlesbrough, UK.
¹³ Department of Physiotherapy, Alfred Health, Melbourne, VIC, Australia.
¹⁴ Respiratory Research, Monash University, Melbourne, VIC, Australia.
¹⁵ Lab3R-Respiratory Research and Rehabilitation Laboratory, School of Health Sciences (ESSUA), Institute of Biomedicine (iBiMED), University of Aveiro, Aveiro, Portugal.
¹⁶ Department of Physiotherapy, Royal Prince Alfred Hospital, Camperdown, NSW, Australia.
¹⁷ Division of Pulmonary Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada.
¹⁸ G.F. MacDonald Centre for Lung Health, Covenant Health, Edmonton, AB, Canada.
¹⁹ Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada.
²⁰ Centre for Heart Lung Innovation, University of British Columbia, Vancouver, BC, Canada.
²¹ Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.
²² School of Rehabilitation Science, Faculty of Health Science, McMaster University, IAHS, 1400 Main St. W, Hamilton, ON, L8S 1C7, Canada. [email protected].
²³ Department of Respiratory Medicine, West Park Healthcare Centre, Toronto, ON, Canada. [email protected].

Abstract

Background and objectives: Available evidence suggests that adults with chronic obstructive pulmonary disease (COPD) performed substantially worse than healthy controls on many balance measures and balance training can improve the balance measures in this population. We conducted this study to determine the effects of incorporating balance training into pulmonary rehabilitation (PR) on the incidence of falls at 12 months follow-up in high fall risk adults with COPD.

Methods: We conducted a prospective international multi-center randomized controlled trial. Eligible participants were adults with COPD at a high risk of future falls and were randomly assigned (1:1) to the intervention or control group. The intervention included personalized balance training for a targeted total of 90 min per week. Both the intervention and control groups received usual PR (2-3 times per week for 8-12 weeks). The primary outcome was the incidence of falls at 12-month follow-up using monthly fall diary calendars. Negative binomial regression or recurrent events models were used to examine the effects of the intervention on fall events. Multiple imputations were performed to deal with missing values.

Results: Of 258 participants who were enrolled in the trial, 178 provided falls information (intervention group = 91, control group = 87) and were included in the main analysis. Forty-one participants (45%) experienced at least one fall event in the intervention group and 33 (38%) in the control group (p = 0.34). The mean incidence of falls at 12 months was similar between the two groups (128 versus 128 per 100 person-years; mean difference: 0.30, 95% CI: -0.76 to 1.36 per 100 person-years). The results are robust after multiple imputations for missing data (n = 67).

Conclusions: PR incorporating balance training compared to PR alone did not reduce the incidence of falls over the 12-month period in high fall risk adults with COPD.

Trial registration: The study was registered with ClinicalTrials.gov (NCT02995681) on 14/12/2016.

Keywords: Accidental falls; COPD; Exercise therapy; Physical therapy.

Publication types

Randomized Controlled Trial
Multicenter Study

MeSH terms

Accidental Falls* / prevention & control
Accidental Falls* / statistics & numerical data
Aged
Exercise Therapy / methods
Female
Humans
Incidence
Male
Middle Aged
Postural Balance*
Prospective Studies
Pulmonary Disease, Chronic Obstructive* / physiopathology
Pulmonary Disease, Chronic Obstructive* / rehabilitation

Associated data

ClinicalTrials.gov/NCT02995681