@article {Smithrespcare.04109, author = {Michelle D Smith and Elizabeth H Harvey and Wolbert van den Hoorn and Barbara L Shay and Gis{\`e}le M Pereira and Paul W Hodges}, title = {Out-Patient Pulmonary Rehabilitation Improves Medial-Lateral Balance in Subjects With Chronic Respiratory Disease: Proof-of-Concept Study}, elocation-id = {respcare.04109}, year = {2016}, doi = {10.4187/respcare.04109}, publisher = {Respiratory Care}, 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{\textendash}12.8] vs post-PR = 8.1 [7.3{\textendash}12.2] s, P = .003) and Four Square Step Test (median [interquartile range] pre-PR = 9.3 [7.2{\textendash}14.2] vs post-PR = 8.7 [7.4{\textendash}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.}, issn = {0020-1324}, URL = {https://rc.rcjournal.com/content/early/2016/01/26/respcare.04109}, eprint = {https://rc.rcjournal.com/content/early/2016/01/26/respcare.04109.full.pdf}, journal = {Respiratory Care} }