Validade preditiva de instrumentos de avaliação de equilíbrio e mobilidade funcional para quedas em idosos com doença pulmonar obstrutiva crônica hospitalizados

Abstract

Introduction: Chronic Obstructive Pulmonary Disease (COPD) is a chronic respiratory condition with high morbidity and mortality rates. Frequent exacerbations and hospitalizations in COPD patients can worsen functional mobility and postural balance, increasing the risk of falls. Although there are several widely used balance tests, the predictive validation of these instruments specifically in hospitalized COPD patients remains limited. Objective: To explore the predictive validity of clinical assessment tools for balance and functional mobility in predicting falls within six months after hospital discharge in COPD patients. Methodology: A prospective cohort study in hospitalized COPD patients. The evaluation included balance and functional mobility tests, including the Brief Balance Evaluation Systems Test (Brief-BESTest), the singleleg stance test, the Timed Up and Go (TUG), the 4-meter walking speed test, clinical characteristics, and pulmonary function prior to hospital discharge. Fall risk was prospectively tracked through a fall calendar and monthly calls for six months. Statistical analyses included multivariate regression techniques to assess the predictive ability of the tests and their relationship with factors such as age, length of hospital stay, and number of comorbidities. Results: The sample included 23 hospitalized COPD patients, with an average age of 71.6±7.2 years and FEV1 52.5±22.1% predicted. During follow-up, the fall incidence was 13% of the sample, indicating low prospective prevalence, despite a history of falls in 21.7% of participants. Among the tests assessed, the TUG was the only one to show a significant association with fall risk, with TUG associated with hospital stay duration (p = 0.014) and age (p = 0.023). The other instruments did not demonstrate significant fall prediction. Conclusion: The TUG is a predictive tool for falls in hospitalized COPD patients, especially concerning changes in functional mobility. The other assessed instruments showed limitations in this context. The study emphasizes the need for early balance assessment in the hospital environment and proposes the use of TUG as a clinical tool.