Department of Physical Therapy, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand.
Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong.
Arch Phys Med Rehabil. 2020 Sep;101(9):1590-1602. doi: 10.1016/j.apmr.2020.01.016. Epub 2020 Feb 28.
To systematically review the evidence for balance impairment and effectiveness of interventions on balance in people with chronic obstructive pulmonary disease (COPD).
Four electronic databases (Scopus, CINAHL, PubMed, Cochrane Library databases) were searched from inception until June 30, 2019.
Two reviewers independently searched with keywords focusing on COPD, postural control, and exercise. Cross-sectional studies related to balance and randomized controlled trials (RCTs) related to the effectiveness of exercise intervention on balance outcomes were included.
Two reviewers independently extracted data of balance impairment on participants, exercise training on balance outcome measures. Methodological quality of cross-sectional studies was assessed using the National Institutes of Health (NIH) Quality Assessment Tool. Methodological quality of RCTs was assessed using the Physiotherapy Evidence Database (PEDro) scale and bias was analyzed using the Cochrane risk of bias.
A narrative review with descriptive synthesis was used. Fifteen cross-sectional studies and 4 RCTs met the final inclusion criteria. The quality of 10 cross-sectional studies were rated as moderate to high (NIH score≥7). Most studies demonstrated impaired balance in people with COPD than in people without COPD. The quality of all included RCTs was good to excellent (PEDro score=6-9). One RCT had a low risk of bias. Generally, pulmonary rehabilitation program combined with balance training, Tai Chi, and cycling exercise showed significant improvement in balance in people with COPD.
Impaired balance is evident in people with COPD. Available RCTs suggest that exercise interventions may improve balance performance in COPD patients. However, more research on the effect of exercise interventions on balance in COPD patients is still required.
系统评价慢性阻塞性肺疾病（COPD）患者平衡障碍的证据和干预措施对平衡的有效性。
从建库到 2019 年 6 月 30 日，四个电子数据库（Scopus、CINAHL、PubMed、Cochrane Library 数据库）进行了搜索。
两名审查员使用专注于 COPD、姿势控制和运动的关键词进行独立搜索。纳入与平衡相关的横断面研究和与运动干预对平衡结果的有效性相关的随机对照试验（RCT）。
两名审查员独立提取参与者平衡障碍、平衡结局测量的运动训练数据。使用美国国立卫生研究院（NIH）质量评估工具评估横断面研究的方法学质量。使用物理治疗证据数据库（PEDro）量表评估 RCT 的方法学质量，并使用 Cochrane 偏倚分析进行偏倚分析。
采用叙述性综述和描述性综合。15 项横断面研究和 4 项 RCT 符合最终纳入标准。10 项横断面研究的质量被评为中等到高度（NIH 评分≥7）。大多数研究表明，COPD 患者的平衡能力比非 COPD 患者差。所有纳入的 RCT 质量均为良好至优秀（PEDro 评分=6-9）。一项 RCT 存在低偏倚风险。一般来说，肺康复计划结合平衡训练、太极拳和骑自行车运动可显著改善 COPD 患者的平衡能力。
COPD 患者存在明显的平衡障碍。现有的 RCT 表明，运动干预可能改善 COPD 患者的平衡表现。然而，仍需要更多关于运动干预对 COPD 患者平衡影响的研究。
