Dizziness, Lower Limb Weakness, and Falls in COPD: A Prospective Longitudinal Pilot Study Using Monthly Home Diaries
Danielle Ferreira de Santana Silva, Bianca Maria Santos Alcântara, Jefferson Ricardo Santos da Silva, Rafaela Pedrosa, Eduardo Eriko Tenório de França, José Heriston de Morais LimaABSTRACT
Background and Purpose
Falls affect approximately half of individuals with chronic obstructive pulmonary disease (COPD) and are associated with hospitalization, accelerated functional decline, and early institutionalization. Existing evidence suggests that single‐visit assessments have limited and inconsistent ability to predict the future falls in individuals with COPD, highlighting the need for alternative longitudinal approaches. To our knowledge, this is the first prospective study to explore the longitudinal association between diary‐recorded symptoms and falls in COPD.
Methods
Prospective observational cohort pilot study ( n = 27), with 6‐month follow‐up. Falls and seven symptom variables were recorded monthly via structured home diaries, complemented by a standardised monthly telephone/messaging follow‐up. Receiver operating characteristic (ROC) curves with 95% bootstrap confidence intervals (CI) and optimal cut‐off points using the Youden index were calculated, with internal validation by optimism‐correction bootstrap. Mann–Whitney U tests compared groups ( α = 0.05).
Results
Thirteen patients (48.1%) experienced at least one fall. Dizziness showed the strongest discrimination in this sample (area under the ROC curve [AUC] = 0.813; optimism‐corrected 0.81; p = 0.002; optimal cut‐off ≥ 1 month; specificity 85.7%; positive likelihood ratio [+LR] 4.84). Lower limb weakness for ≥ 2 months was the most sensitive discriminating variable (AUC = 0.739; p = 0.034; sensitivity 92.3%). Among baseline physiological measures, only the FEV1/FVC ratio showed acceptable discrimination (AUC = 0.734; p = 0.041), in a paradoxical direction (higher among fallers); Timed Up and Go, maximal inspiratory pressure, and quadriceps ultrasound did not significantly discriminate fallers from non‐fallers.
Discussion
Longitudinal symptom monitoring via monthly home diaries showed higher apparent discrimination than single‐visit baseline assessments in this pilot sample. These findings are exploratory and hypothesis‐generating, supporting a confirmatory study with an adequate sample size. Monthly diary monitoring is low‐cost, feasible by telephone, and may represent a complementary approach to fall risk assessment in COPD.
Trial Registration
Registered on ClinicalTrials.gov, identifier NCT06827379 (PI: Eduardo Eriko Tenório de França)