The Risk of Falling in Patients With Chronic Obstructive Pulmonary Disease

Study Overview
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Brief Summary
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This cross-sectional study aims to investigate what daily activities increase the risk of falling in Chronic Obstructive Pulmonary Disease patients (COPD).

Detailed Description
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To investigate the what daily activities increase the risk of falling in patients with COPD, twenty-eight voluntary patients with COPD, aged between 35-80 years will be divided into two groups: Group-1 have at least one fall (fallers) and Group-2 have no history of falls (non-fallers). Fall frequency will be investigated by asking patients to report any fall event in the last one month and the last 12-months. Assessments will be performed at baseline. Fear of falling will be assessed with Activities-Specific Balance Confidence (ABC) scale. Balance will be evaluated by Berg Balance Scale (BBS). The level of dyspnea during daily activities will be assessed with London Chest Activity of Daily Living (LCADL) scale. The global impacts of COPD symptoms on overall health status will be evaluated by The COPD Assessment Test (CAT). The Modified Medical Research Council Dyspnea (MMRC) scale and Six-Minute Walking Test (6MWT) will be used for evaluating the how dyspnea limits the patients' daily activities and functional capacity, respectively. Isometric muscle strength will be measured with a handheld dynamometer of quadriceps femoris. Pulmonary function data will be retrieved from the last 1-month clinical records of the COPD patients. Statistical analysis will be performed using the Statistical Package for Social Sciences (SPSS) version 21.0. Among the groups, demographic and clinical variables will be compared with independent sample t-test for continuous variables and a chi-square test for categorical variables. The significance level will be set as p<0.05.

Official Title
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What Daily Activities Increase the Risk of Falling in Chronic Obstructive Pulmonary Disease Patients?

Conditions
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Chronic Obstructive Pulmonary Disease, Fall, Balance; Distorted, Activity, Motor

Intervention / Treatment
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* Other: No intervention


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: stable disease (no severe exacerbations in the prior 3 months) ability to walk independently ability to read and write in Turkish able to follow simple instructions no pathology in visual ability and hearing Exclusion Criteria: a history of specific balance problems (i.e., diagnosed vestibular or neurological disorder) severe musculoskeletal, neurological or cardiovascular disorders that limit mobility use of medication(s) that may increase the risk of falls participate in pulmonary rehabilitation in the lasts six months

Ages Eligible for Study
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Minimum Age: 35 Years
Maximum Age: 80 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Group-1<br>The patients were classified based on the frequency of falls in the last 12 months. Group-1 consists of COPD patients whose have at least one fall (fallers) | Other: No intervention<br>* There is no intervention.<br>|
| Group-2<br>The patients were classified based on the frequency of falls in the last 12 months. Group-2 consists of COPD patients whose have no history of falls (non-fallers). | Other: No intervention<br>* There is no intervention.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Activities-Specific Balance Confidence scale | Activities-Specific Balance Confidence (ABC) scale will be used for evaluating the confidence in maintaining the balance in activities daily living. It provides information on the level of concern about falls during16 community-based and home-based activities. Scale scores between 0 (unsafe) to 100 (completely safe) and the total score (0-1600) is divided by 16 to obtain an individual's ABC score, with higher scores indicating greater balance confidence. In patients with COPD, the ABC scale has demonstrated construct validity as well as criterion validity for falls. In addition, the participants will be also questioned concerning the occurrence of falls and the risk of falling during the activity in each item of the ABC scale. | Baseline | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Fall frequency | Fall frequency will be investigated by asking patients to report any fall event in the last one month and the last 12-months. Participants will be asked: Have you had any fall including a slip or trip in which you lost your balance and landed on the floor or ground or lower level? Details about the circumstances of the fall and any resultant injury will be questioned. | Baseline | 
| Berg Balance Scale | Berg Balance Scale (BBS) will be used to assess the balance and determine the risk of falling in participants. It consists of 14-item evaluating a patient's ability to safely balance during a series of physical tasks. Scale scores between 0 (unable/unsafe) to 4 (independent/safe) and the total score ranges from 0 to 56, with higher scores indicating better balance control. The BBS has been demonstrated construct validity in patients with COPD. | Baseline | 
| London Chest Activity of Daily Living scale | London Chest Activity of Daily Living (LCADL) scale is used for assessing the level of dyspnea during daily activities. It is a 15-item scale comprised 4 domains: self-care (4 items), domestic (6 items), physical (2 items), and leisure (3 items). Each item scored between 0 (I wouldn't do it anyway) to 5 (I need help in doing this or someone to do it for me) and the total score ranges from 0 to 75, with higher scores indicating a more significant limitation in daily activities. The LCADL scale is a reliable, valid, and responsive instrument to assess limitations in performing daily activities in COPD patients. asked to rate each item in terms of risk of falling using a five-point scale, where 1=very low, 2=low, 3=moderate, 4=high, and 5=very high. | Baseline | 
| The COPD Assessment Test | The COPD Assessment Test (CAT) will be used for evaluating the global impacts of COPD symptoms on overall health status. Each item scores between 0 to 5 and the total score ranges from 0 to 40, with higher scores indicating the more severe impact of COPD on health status. | Baseline | 
| The strength of quadriceps femoris | The strength of quadriceps femoris of both sides will be measured with a hand-held dynamometer (kg.N-1) ''Nicholas Manual Muscle Tester (model 01160, The Lafayette Instrument Company, Lafayette, Indiana). Each limb will assessed 3 times, with a recovery period of 30 seconds and the mean value will be calculated. | Baseline | 
| The Modified Medical Research Council Dyspnea scale | The Modified Medical Research Council Dyspnea (mMRC) scale will be used to determine how dyspnea limits the patients' daily activities performance. Itis a five-level rating scale consisting of just five items containing statements about the impact of dyspnea on the patients' daily activities performance and leading to a grade from 1 to 5. Higher scores indicate a greater impact of dyspnea on the patients' daily activities performance. | Baseline | 
| Six-Minute Walking Test (6MWT) | Six-Minute Walking Test (6MWT) is a reliable and valid test for evaluating functional capacity. Two 6MWTs will be performed according to the guidelines of the American Thoracic Society. The distance in meters covered over the 6 minutes of the test (6MWD) will be recorded. | Baseline |