title: Out-Patient Pulmonary Rehabilitation Improves Medial-Lateral Balance in Subjects With Chronic Respiratory Disease: Proof-of-Concept Study.
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. (ClinicalTrials.gov registration NCT00864084.).
authors.affiliation: School of Health and Rehabilitation Sciences, The University of Queensland, St. Lucia, Queensland, Australia. m.smith5@uq.edu.au.
authors.forename: Michelle D
authors.initials: MD
authors.lastname: Smith
authors.affiliation: School of Medical Rehabilitation, University of Manitoba, Winnipeg, Manitoba, Canada.
authors.forename: Elizabeth H
authors.initials: EH
authors.lastname: Harvey
authors.affiliation: School of Health and Rehabilitation Sciences, The University of Queensland, St. Lucia, Queensland, Australia.
authors.forename: Wolbert
authors.initials: W
authors.lastname: van den Hoorn
authors.affiliation: School of Medical Rehabilitation, University of Manitoba, Winnipeg, Manitoba, Canada.
authors.forename: Barbara L
authors.initials: BL
authors.lastname: Shay
authors.affiliation: School of Medical Rehabilitation, University of Manitoba, Winnipeg, Manitoba, Canada.
authors.forename: Gisèle M
authors.initials: GM
authors.lastname: Pereira
authors.affiliation: School of Health and Rehabilitation Sciences, The University of Queensland, St. Lucia, Queensland, Australia.
authors.forename: Paul W
authors.initials: PW
authors.lastname: Hodges
mesh_terms: D000368:Aged; D002908:Chronic Disease; D005080:Exercise Test / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010045:Outpatients; D004856:Postural Balance / Q000502:physiology*; D012120:Respiration Disorders / Q000503:physiopathology / Q000534:rehabilitation*; D012138:Respiratory Therapy / Q000379:methods*; D012678:Sensation Disorders / Q000209:etiology / Q000628:therapy*; D016896:Treatment Outcome
keywords: balance; chronic respiratory disease; exercise; pulmonary rehabilitation