Association between clinical, functional and psychosocial factors with postural balance and falls in individuals with Chronic Obstructive Pulmonary Disease: A Prospective study with Follow-Up

• Grant number: 25/25905-3
• Support Opportunities: Scholarships in Brazil - Doctorate
• Start date: March 01, 2026
• End date: February 28, 2030
• Field of knowledge: Health Sciences - Physiotherapy and Occupational Therapy
• Principal Investigator: Celso Ricardo Fernandes de Carvalho
• Grantee: Barbara Aparecida Teodoro Alcantara Verri
• Host Institution: Faculdade de Medicina (FM). Universidade de São Paulo (USP). São Paulo , SP, Brazil

Abstract

Background: Individuals with Chronic Obstructive Pulmonary Disease (COPD) present multiple comorbidities that increase falls risk. However, the association between falls and clinical, functional, and psychosocial factors in this population remains poorly understood. Aim:1) To evaluate clinical, functional, and psychosocial factors associated with falls in individuals with moderate to very severe COPD; 2) To identify risk factors for falls in this population; and 3) To assess the clinical and environmental hazards of falls and their impact on individuals with COPD. Methods: This is a prospective follow-up study consisting of three assessment, each separated by seven days. On the first day, participants will realize an initial assessment and the Charlson Comorbidity Index (CCI), dyspnea (Dyspnea-12), health status (COPD Assessment Test, CAT), anxiety and depression symptoms (Hospital Anxiety and Depression Scale, HADS), fatigue (Functional Assessment of Chronic Illness Therapy-Fatigue Scale, FACIT-F), and clinical postural balance (Mini-Balance Evaluation Systems Test, Mini-BESTest). Participants will also perform dual-task testing and complete pulmonary function tests. After these assessments, participants will use the Biologix® device (Oxistart, Biologix Sistemas Ltd., Brazil) for three consecutive nights to quantify nocturnal hypoxemia. After seven days, participants will return the Biologix device and will assessment, including cognition (Addenbrooke's Cognitive Examination-Revised, ACE-R), health-related quality of life (Chronic Respiratory Questionnaire, CRQ), nutritional status (bioimpedance analysis), handgrip strength (Lafayette Instrument®, Model 5030DG, IN, USA), maximal voluntary isometric strength of quadriceps, dorsiflexors, and plantar flexors (Lafayette Instrument®, Model 01165A, LA, USA), and functional capacity (six-minute walk test, 6MWT). After the assessment, participants will receive an accelerometer (Actigraph LLC, Pensacola, FL, USA) and a physical activity diary. On the third assessment, participants will return the accelerometer and answer the Falls Efficacy Scale-International (FES-I). Gait will be evaluated using the 10-meter walk test, and postural balance will be assessed using a force platform (AMTI®). At the end of this visit, participants will receive a fall diary to record fall events regarding date, location, and circumstances. Individuals will be monitoring during 12 months through by phone calls. In the first month of follow-up, participants will complete the Home Falls and Accidents Screening Tool - Home FAST Brazil (self-reported version) to evaluate environmental risk factors. After the follow-up period, participants will be categorized into two groups according to fall occurrence: Falls Group (one or more falls) and the Non-Falls Group (no falls). Statistical Analysis: Data normality will be checking using the Kolmogorov-Smirnov test. Group comparisons (Falls, Non-Falls, and Recurrent Falls) will be conducted using one-way ANOVA followed by Bonferroni post hoc tests or the Kruskal-Wallis test with Dunn's post hoc, as appropriate. Two-way ANOVA with Tukey's post hoc test will be used to compare post-exertion balance among groups. Multiple logistic regression will assess the association between the dependent variable (falls) and independent clinical, functional, and anthropometric variables. Multiple linear regression analyses will explore associations between postural balance outcomes (Mini-BESTest and force platform parameters) and clinical, anthropometric, and functional variables. (AU)