An investigation of the impact of pain on falls risk, balance and gait in people with Chronic Obstructive Pulmonary Disease

Student thesis: Doctoral Thesis


Background: Chronic Obstructive Pulmonary Disease (COPD) is a chronic respiratory condition characterised by airflow limitation, breathlessness, reduced exercise capacity and increased sputum production. People with COPD are four times more likely to fall than healthy peers, which has been attributed to balance impairments. Gait impairments have also been highlighted in people with COPD and are also a risk factor for falls. People with COPD also have a higher prevalence of pain than people without COPD and pain has been associated with greater falls risk in older adults without COPD. Despite this the impact of pain on falls risk and on balance and gait impairment is unknown but necessary to inform effective interventions for balance and gait impairments in people with COPD.
Aims: The aims of this thesis are to understand the impact of pain on falls risk and balance and gait impairment in people with COPD.
Methods and results: A secondary data analysis of a large longitudinal panel study was performed to establish the risk of incident falls on people with COPD and pain compared with healthy controls. Findings suggest that people with COPD and pain have a greater falls risk than both people with COPD no pain and than healthy controls with pain, which increases incrementally with pain severity. A systematic review of the literature was conducted to search for studies comparing balance and gait outcomes in people with COPD compared with healthy controls. Results indicate that people with COPD have slower gait speed and clinically meaningful balance impairments which are associated with muscle weakness but not airflow limitation. A cross sectional observational study was undertaken measuring balance, gait and pain outcomes in people with COPD. Data indicates that balance is impaired and gait speed is slower in people with COPD and persistent pain compared to people with COPD and no persistent pain. Pain severity, reduced ankle muscle strength, poor muscle endurance and poor dual tasking ability all appear to influence balance and gait impairment.
Conclusions: Pain, particularly moderate to severe pain, could have deleterious effects on balance and gait in people with COPD. Pain appears to enhance the effect of systemic muscle weakness and muscle endurance and impair automatic gait. People with COPD and pain should be identified as potentially being at risk of falls and have their balance and gait assessed.
Date of Award1 Mar 2022
Original languageEnglish
Awarding Institution
  • Teesside University
SupervisorSamantha Harrison (Supervisor), Denis Martin (Supervisor) & John Dixon (Supervisor)

Cite this