Out-patient pulmonary rehabilitation improves medial-lateral balance in people with chronic respiratory disease: Proof-of-concept study

Smith, Michelle D., Harvey, Elizabeth H., van den Hoorn, Wolbert, Shay, Barbara L., Pereira, Gisèle M. and Hodges, Paul W. (2016) Out-patient pulmonary rehabilitation improves medial-lateral balance in people with chronic respiratory disease: Proof-of-concept study. Respiratory Care, 61 4: 510-520. doi:10.4187/respcare.04109


Author Smith, Michelle D.
Harvey, Elizabeth H.
van den Hoorn, Wolbert
Shay, Barbara L.
Pereira, Gisèle M.
Hodges, Paul W.
Title Out-patient pulmonary rehabilitation improves medial-lateral balance in people with chronic respiratory disease: Proof-of-concept study
Journal name Respiratory Care   Check publisher's open access policy
ISSN 0020-1324
1943-3654
Publication date 2016-04-01
Sub-type Article (original research)
DOI 10.4187/respcare.04109
Open Access Status Not Open Access
Volume 61
Issue 4
Start page 510
End page 520
Total pages 11
Place of publication Irving, TX, United States
Publisher Daedalus Enterprises
Collection year 2017
Language eng
Formatted abstract
BACKGROUND: Recent studies show balance impairment in subjects with chronic respiratory disease. The aim of this proof-of-concept study was to investigate clinical and quantitative measures of balance in people with chronic respiratory disease following participation in an out-patient pulmonary rehabilitation (PR) program to better understand features of balance improvement. A secondary aim was to probe possible mechanisms for balance improvement to provide the foundation for optimal design of future studies.

METHODS: Eleven individuals with chronic respiratory disease enrolled in an 8-week out-patient PR program participated. Standing balance, measured with a force plate, in the medial-lateral and anterior-posterior directions with eyes open and closed was assessed with linear (SD and sway path length) and non-linear (diffusion analysis) center-of-pressure measures. Balance was evaluated clinically with the Timed Up and Go and Four Square Step Test. Fear of falling and balance confidence were assessed with questionnaires.

RESULTS: After participation in PR, medial-lateral sway path length decreased (P = .031), and center-of-pressure diffusion in the medial-lateral direction was slower (P = .02) and traveled over less distance (P = .03) with eyes closed. This suggests greater control of medial-lateral sway. There was no change in anterior-posterior balance (P > .067). Performance improved on the Timed Up and Go (median [interquartile range] pre-PR = 9.4 [7.9–12.8] vs post-PR = 8.1 [7.3–12.2] s, P = .003) and Four Square Step Test (median [interquartile range] pre-PR = 9.3 [7.2–14.2] vs post-PR = 8.7 [7.4–10.2] s, P = .050). There were no changes in balance confidence (P = .72) or fear of falling (P = .57).

CONCLUSIONS: Participation in an 8-week out-patient PR program improved balance, as assessed by clinical and laboratory measures. Detailed analysis of force plate measures demonstrated improvements primarily with respect to medial-lateral balance control. These data provide a basis for the development of larger scale studies to investigate the mechanisms for medial-lateral balance improvements following PR and to determine how PR may be refined to enhance balance outcomes in this population.
Keyword Balance
Chronic respiratory disease
Exercise
Pulmonary rehabilitation
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: HERDC Pre-Audit
School of Health and Rehabilitation Sciences Publications
 
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Created: Thu, 31 Mar 2016, 11:00:52 EST by Dr Michelle Smith on behalf of School of Health & Rehabilitation Sciences