Effects of pulmonary rehabilitation on fear of falling in Chronic Obstructive Pulmonary Disease (COPD) patients: An observational study.

Objective: COPD patients have more fear of falling (FOF) in comparison with control population. One major aim of pulmonary rehabilitation (PR) is to maintain physical activity. Studies show that FOF can limit physical activity. The aim of this study was to assess the impact of PR on FOF in patients with COPD.

Methods: From January to august 2019, COPD patients (stage 2 to 4) undergoing a 4-weeks PR Program (PRP) at Morlaix Hospital Centre were included in this prospective observational study. The objectives were to assess [1] the impact of PR on FOF, [2] the correlations between evolution of FOF and evolution of parameters usually used during PRP, [3] to determine a MID for FOF. The primary endpoint was the Fall Efficacy Scale-International (FES-I) questionnaire. The secondary endpoints were tests and questionnaires usually used to assess exercise capacity, quality of life, dyspnea, anxiety, depression, and balance.

Results: 80 patients were included and 72 were analysed. After the PRP, there was a significant decrease of FOF, with significative decrease of FES-I score (-3.36, p<0.001) CI 95% [-5.1; -1.6]). The evolution of FES-I score was moderately correlated to changes in quality of life (QOL) using CAT (Intra-class Correlation Coefficient (ICC)=0.340, p=0.005) and SGRQ (ICC=0.454, p<0.0001), dyspnea using MMRC (ICC=0.311, p=0.009) and LCADL (ICC=0.396, p=0.001); and weakly correlated to changes in balance (ICC=-0.280, p=0.026). Using the distribution-based analysis, we found a MID between -3.6 to -4.9.

Conclusion: We showed a significant decrease of fear of falling in COPD patients after PRP, correlated with improvement of QOL, balance and decrease of dyspnea. We propose a MID of -4.9 for FES-I.

Trial Registration: ClinicalTrials.gov NCT03793452.