Chauvin Stephanie, Kirkwood Renata, Brooks Dina, Goldstein Roger S, Beauchamp Marla K
School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada.
Department of Respiratory Medicine, West Park Healthcare Centre, Toronto, Ontario, Canada.
Int J Chron Obstruct Pulmon Dis. 2020 Jul 1;15:1557-1564. doi: 10.2147/COPD.S253561. eCollection 2020.
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.
A secondary analysis of cross-sectional data from two prior studies in COPD was performed. Independent samples -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.
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%.
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.
慢性阻塞性肺疾病（COPD）是一种日益普遍的肺部疾病，与平衡功能障碍及跌倒风险增加有关。平衡评估系统测试（BESTest）可评估功能平衡的六个潜在子成分。本研究的目的是确定区分慢性阻塞性肺疾病患者跌倒者与非跌倒者的特定平衡子成分及临界值，以指导跌倒风险评估和预防。
对之前两项慢性阻塞性肺疾病研究的横断面数据进行二次分析。采用独立样本t检验探讨跌倒者与非跌倒者在BESTest子系统得分上的差异。使用受试者工作特征曲线确定识别跌倒者的最佳子成分临界值，并使用曲线下面积（AUC）评估测试准确性。
分析了72例慢性阻塞性肺疾病患者的数据（平均年龄70.3±7.4岁；1秒用力呼气量平均为预测值的38.9±15.8%）。BESTest的两个子成分，即稳定极限/垂直度（跌倒者：75.4%，非跌倒者：83.8%；p=0.002）和姿势反应（跌倒者：67.5%，非跌倒者：79.7%；p=0.008）可区分跌倒者与非跌倒者。稳定极限/垂直度识别跌倒者的AUC为0.70，最佳临界值为73.8%；姿势反应的AUC为0.67，最佳临界值为69.4%。
BESTest的稳定极限/垂直度和姿势反应子成分可区分慢性阻塞性肺疾病患者中的跌倒者与非跌倒者。稳定极限/垂直度子成分也可用于通过73.8% 的临界值识别慢性阻塞性肺疾病患者是否有跌倒风险。这些发现表明，可以针对特定的平衡子成分来优化慢性阻塞性肺疾病患者的跌倒风险评估和预防。
