Falls in people with chronic obstructive pulmonary disease : risk factors, incidence and impact on health related quality of life

Introduction: People with chronic conditions show increased susceptibility to falls, however, little is known about the risk factors, incidence and impact of falls on people with chronic obstructive pulmonary disease (COPD). Purposes: The purposes of this thesis were to: 1) provide a theoretical framework for identifying risk factors for falls in COPD. 2) compare physical risk factors for falls in people with COPD and healthy people and; 3) determine risk factors, incidence and impact of falls on health related quality of life (HRQoL) in COPD. Methods: The first study (Chapter 2) was a literature review for identifying risk factors for falls in COPD. The second study (Chapters 3-6) was a cross sectional design that compared 21 people with COPD and 21 healthy participants. We investigated: 1) thigh muscle strength, cross sectional area (CSA) and quality; 2) functional performance, including the Self-Selected Gait-Speed, Stair Climbing Power, Repetitive Sit-To-Stand, Timed Up-and-Go and Six-Minute Walk tests; 3) postural control using the Sensory Organization Test. The third study (Chapter 7) was a 6-month prospective survey study that investigated fall incidence and HRQoL as reflected by the Health Survey Short Form (SF-36) and the Chronic Respiratory Questionnaire (CRQ) in 101 people with COPD. Results Chapter 2: Risk factors for falls are present in COPD. Chapter 3-6: People with COPD showed deficits in knee extensors muscle strength (p≤0.016), CSA (p=0.008) and quality (p=0.003) as well as knee flexors concentric strength (p=0.024) and quality (p=0.005). Functional performance (p≤0.002) and postural control (p=0.014) were reduced in people with COPD. Chapter 7: People with COPD showed an incidence rate of 0.1 falls per person-month (95% CI: 0.06 to 0.14). Fallers showed lower scores in the baseline physical domains of HRQoL. Falls appeared to lower the dyspnea domain of the CRQ (p=0.017). Predictors of falls in COPD were: the number of previous falls (OR=7.36), coronary heart disease (OR=7.07), female gender (OR=3.73) and age (OR=1.09). Conclusions Risk factors and incidence of falls are increased in people with COPD and can result in significant deterioration of HRQoL related to dyspnea. Fall prevention strategies in people with COPD are recommended.Medicine, Faculty ofGraduat