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      Which Balance Subcomponents Distinguish Between Fallers and Non-Fallers in People with COPD?

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          Abstract

          Rationale

          Chronic obstructive pulmonary disease (COPD) is an increasingly prevalent lung disease linked to dysfunctional balance and an increased risk of falls. The Balance Evaluation Systems Test (BESTest) evaluates the six underlying subcomponents of functional balance. The aim of this study was to determine the specific balance subcomponents and cut-off scores that discriminate between fallers and non-fallers with COPD to guide fall risk assessment and prevention.

          Methods

          A secondary analysis of cross-sectional data from two prior studies in COPD was performed. Independent samples t-tests were used to explore the differences in the BESTest sub-system scores between fallers and non-fallers. Receiver operating characteristic curves were used to determine the optimal subcomponent cut-off scores that identified fallers, and the area under the curve (AUC) was used to assess test accuracy.

          Results

          Data from 72 subjects with COPD (mean age, 70.3 ± 7.4y; mean forced expiratory volume in 1 second, 38.9 ± 15.8% predicted) were analyzed. Two BESTest subcomponents, stability limits/verticality (fallers: 75.4%, non-fallers: 83.8%; p=0.002) and postural responses (fallers: 67.5%, non-fallers: 79.7%; p=0.008) distinguished between fallers and non-fallers. Stability limits/verticality had an AUC of 0.70 and optimal cut-off score of 73.8% for identifying fallers; postural responses had an AUC of 0.67 and optimal cut-off score of 69.4%.

          Conclusion

          The stability limits/verticality and postural responses subcomponents of the BESTest distinguished between fallers and non-fallers with COPD. The stability limits/verticality subcomponent can also be used to identify whether an individual with COPD is at risk of falling using a cut-off score of 73.8%. These findings suggest that specific subcomponents of balance could be targeted to optimize fall risk assessment and prevention in COPD.

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          Most cited references 17

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          Summary of the Updated American Geriatrics Society/British Geriatrics Society clinical practice guideline for prevention of falls in older persons.

            (2010)
          The following article is a summary of the American Geriatrics Society/British Geriatrics Society Clinical Practice Guideline for Prevention of Falls in Older Persons (2010). This article provides additional discussion of the guideline process and the differences between the current guideline and the 2001 version and includes the guidelines' recommendations, algorithm, and acknowledgments. The complete guideline is published on the American Geriatrics Society's Web site (http://www.americangeriatrics.org/health_care_professionals/clinical_practice/clinical_guidelines_recommendations/2010/). © 2011, Copyright the Authors. Journal compilation © 2011, The American Geriatrics Society.
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            Rectangular Confidence Regions for the Means of Multivariate Normal Distributions

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              Guideline for the Prevention of Falls in Older Persons

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                Author and article information

                Journal
                Int J Chron Obstruct Pulmon Dis
                Int J Chron Obstruct Pulmon Dis
                COPD
                copd
                International Journal of Chronic Obstructive Pulmonary Disease
                Dove
                1176-9106
                1178-2005
                01 July 2020
                2020
                : 15
                : 1557-1564
                Affiliations
                [1 ]School of Rehabilitation Science, McMaster University , Hamilton, Ontario, Canada
                [2 ]Department of Respiratory Medicine, West Park Healthcare Centre , Toronto, Ontario, Canada
                [3 ]Department of Physical Therapy, University of Toronto , Toronto, Ontario, Canada
                [4 ]Department of Medicine, University of Toronto , Toronto, Ontario, Canada
                [5 ]Firestone Institute for Respiratory Health, St. Joseph’s Healthcare , Hamilton, Ontario, Canada
                Author notes
                Correspondence: Marla K Beauchamp McMaster University , 1400 Main Street West, Hamilton, ONL8S 1C7, IAHS 430CanadaTel +1 905 525-9140 x 21732 Email beaucm1@mcmaster.ca
                Article
                253561
                10.2147/COPD.S253561
                7335868
                © 2020 Chauvin et al.

                This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms ( https://www.dovepress.com/terms.php).

                Page count
                Figures: 2, Tables: 4, References: 30, Pages: 8
                Funding
                Funded by: Emerging Research Leaders Initiative from the Canadian Respiratory Research Network
                Funded by: Labarge Mobility Scholarship from the McMaster Institute for Research on Aging
                Funded by: Canadian Institutes of Health Research 10.13039/501100000024
                M Beauchamp is supported by an Emerging Research Leaders Initiative from the Canadian Respiratory Research Network. S Chauvin is supported by a Labarge Mobility Scholarship from the McMaster Institute for Research on Aging, and a Canada Graduate Scholarship-Master’s from the Canadian Institutes of Health Research. D Brooks holds a National Sanitarium Chair in Respiratory Rehabilitation.
                Categories
                Original Research

                Respiratory medicine

                falls, rehabilitation, balance, bestest, chronic obstructive pulmonary disease

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