Previous finding suggested a cut-off score ≤45 as the risk of falling in community-dwelling adults ( 14). The maximum score of 14-task items is 56, the lower score indicates a larger risk of falling and balance impairment. In each task, the scores are classified from 0 (unable) to 4 (independent). The BBS includes 14 items for assessment of activities of daily living (ADL) tasks and is considered as the gold standard for testing static and dynamic balance abilities ( 27). Therefore, the BBS was selected for using in this study. The BBS has more evidence for its psychometric properties than tests such as the Mini- Balance Evaluation Systems Test (BESTest) ( 7), and that the BBS has been more frequently used in the literature and clinical practice. This test was performed after the patients completed all questionnaires and spirometry. The balance test was measured by a physical therapist using the BBS in all subjects. We used the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines for reporting this cross-sectional study ( 22). Before enrollment, written informed consent was obtained from all subjects. The study was approved by the Research Ethics Committee [Institutional Review Board (IRB) approval number: MED-2558-03253, date of approval: 12 October 2015 and filed under Clinical Trials Registry (study ID: TCTR20151015001, date of approval: 15 October 2015). All tests including the BBS, the TUG test, and the single test of 6-MWT were performed by the same well trained physical therapist. Testing was also performed for visual deficits by using the Snellen chart ( 20) and detection of anxiety or depression using the Thai version of Hospital Anxiety and Depression Scale (HADS) ( 21). George’s Respiratory Questionnaire (SGRQ) ( 16), the Thai version of COPD assessment test (CAT) ( 17), the modified Medical Research Council (mMRC) dyspnea scale ( 18), and six-minute walk test (6-MWT) ( 19) were utilized. In addition to the standard assessments at our COPD clinic, the St. The demographic and clinical data including age, sex, body mass index (BMI), co-morbidity, lung function, severity of COPD, history of a fall in the previous year using the Elderly Falls Screening Test (EFST) ( 15), and history of acute exacerbation of COPD (AECOPD) were collected. A BBS score of ≤45 indicated balance impairment in this study ( 14). Balance tests were measured using the Berg Balance Scale (BBS) and the TUG test. This cross-sectional study was conducted at a single visit in COPD patient at Maharaj Nakorn Chiang Mai Hospital, Chiang Mai, Thailand from November 2015 to October 2017. Therefore, the aim of this study was to examine the diagnostic ability of the TUG test for identifying balance impairment in COPD. However, there are few data regarding the cut-off point of the TUG test that could predict balance impairment in COPD patients. ![]() ( 11) suggest that a cut-off 11 and 12 seconds could predict fall in patients with COPD, respectively. Some studies indicated that the TUG could be used for predicting history of falling and exercise capacity in COPD ( 10- 13). The Timed Up and Go (TUG) test is recommended as a routine screening test for balance impairment and falls in older adults ( 9). A number of tests have been developed to quantitatively measure balance in the elderly population ( 8). Although a balance impairment assessment is now recommended by the guidelines for pulmonary rehabilitation program, specific tests have yet to be suggested ( 7). Balance impairment should be evaluated in older adults including COPD as a screen for identifying individuals who may benefit from a multifactorial fall risk assessment. Therefore, reducing the fall risk is very important and assessment of balance impairment in elderly especially in COPD should be addressed ( 6). ![]() Besides negative effects on mortality and morbidity, falls are linked to poorer overall functional status and quality of life ( 5). The greater fall risk in COPD patients needs more consideration of modifiable factors. also showed that the incidence of falling in patients with COPD was significant higher than non-COPD subjects (44.9 per 1,000 person-years vs. Previous studies showed the incidence of falling in COPD patients varies from 25.0–31.7% ( 2, 3). Falling is a common problem in elderly people including in subjects with chronic obstructive pulmonary disease (COPD) ( 1).
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