1. INTRODUCTION
Owing to its systemic effects, several chronic obstructive pulmonary disease (COPD) are linked with many comorbidities. Although comorbidities such as cachexia, skeletal muscle weakness, and osteoporosis are well-known, the balance impairment and falls resultant from these issues are not adequately emphasized. However, the frequency of the loss of balance and falls is more among patients with COPD than in the normal population.1-3 Several factors are known to contribute to balance impairment in patients with COPD. Of which, the most remarkable factor is developing muscle atrophies due to decreased daily life activities. Quadriceps muscle weakness due to immobilization in patients with COPD is a major risk factor for balance impairment and fall. Hypoxia, oxidative stress, and systemic inflammation play major roles in the development of muscle atrophy.4,5Fractures due to impaired balance and falls increase the resultant morbidity and mortality as a result of decreased quality of life, bed confinement, increased muscle atrophy, and complications such as thromboembolism. Therefore, it has been recently emphasized that the balance impairment should be treated as a part of pulmonary rehabilitation treatment plan.6
Several tests are available for the evaluation and assessment of balance impairment and fall risk in patients with COPD. Although the Berg Balance Scale (BBS) and Balance Evaluation System (BES) tests are the most recommended tests of all,6 these tests are very complicated and time consuming as they evaluate numerous factors that affect the bodily balance of a patient. As a result, it is difficult to apply these tests to the routine outpatient evaluation of patients with COPD. Identifying patients at a high risk of balance impairment and fall with the application of easy-to-use tests at the beginning, followed by performing more detailed tests later is expected to save the times of both the patient and the healthcare worker. The initial tests should be easy to understand and practical. Single Leg Stance (SLS) test, Five Repetition Sit to Stand Test (5STS), Four Step Square Test (FSST), and Timed Up and Go (TUG) test are some easy-to-use tests that can effectively evaluate balance impairment and fall risk.
In this study, we evaluated balance impairment in patients with COPD using tests that are easier to perform than the BBS test.