Background: Chronic obstructive pulmonary disease (COPD) often presents with skeletal muscle dysfunction, which worsens prognosis. Whole-body vibration training (WBVT) has been proposed as an adjunct to pulmonary rehabilitation, but evidence of its clinical efficacy remains inconsistent. Objective: To evaluate the effects of WBVT on functional capacity, muscle strength, pulmonary function, and quality of life in individuals with COPD. Methods: A systematic review and meta-analysis were conducted following PRISMA guidelines and registered in PROSPERO. Only randomized controlled trials were included. Outcomes assessed included 6-minute walk distance (6MWD), five-repetition sit-to-stand test (5STS), pulmonary function, and quality of life. Results: Fifteen RCTs met the inclusion criteria. WBVT significantly improved functional capacity measured by the 6MWD (MD = 34.35 m; 95% CI: 13.67,55.04; GRADE: very low). Subgroup analysis revealed a clinically meaningful improvement compared with usual care (MD = 75.97 m; 95% CI: 58.65,93.30), but not when compared with active exercise interventions. For the 5STS, a clinically relevant gain was observed versus usual care (MD = -5.95 seconds; 95% CI: -10.76, -1.14), with no significant difference compared to conventional exercise. No statistically significant effects were found for FEV₁ or quality of life. Most trials presented high risk of bias, and evidence certainty ranged from low to very low. Conclusion: WBVT may offer benefits in walking distance and sit-to-stand performance only when compared with no rehabilitation exposure, a scenario that is unrealistic in contemporary clinical practice given the strong evidence supporting structured exercise-based pulmonary rehabilitation for COPD management.
Background A severe exacerbation of COPD (ECOPD) may negatively impact patients’ functioning; however, there is a lack of validated, simple, and low-cost tools to assess physical function in this setting. Thus, the aims of this study were to explore the construct validity of the five-repetition sit-to-stand (5STS) test for assessing muscle strength and exercise tolerance, and to investigate its prognostic value in predicting exacerbation-related readmission risk in patients with severe ECOPD. Methods This was a prospective observational study. Fifty-eight patients hospitalized with a severe ECOPD were included. At hospital discharge, the 5STS, quadriceps force, six-minute walk test (6MWT), COPD Assessment Test (CAT), and modified Medical Research Council scale were assessed. Exacerbation-related readmissions within six months were collected. Statistical analyses included correlation analysis, receiver operating characteristic (ROC) curve, and Kaplan-Meier survival analysis. Results 58 patients (mean age of 69 ± 8 years, 45% male, FEV1 41 ± 16% predicted) were included. Within six months, 31% were readmitted. The 5STS showed a significant negative correlation with quadriceps force (r = -0.487) and 6MWT (r = -0.415). The ROC curve analysis demonstrated an AUC of 0.720 (95% CI: 0.588–0.853), with a cut-off of ≥13 seconds identifying patients at higher risk of exacerbation-related readmission. Patients with 5STS <13s had a higher probability of remaining hospitalization-free (86.7%) compared to those with 5STS ≥13s (50%). Conclusion The 5STS is correlated with muscle strength and exercise tolerance and has acceptable prognostic value for predicting exacerbation-related admission within six months in patients with severe ECOPD.
Objective To evaluate the measurement properties of the Brazilian version of the Chelsea Critical Care Physical Assessment Tool (CPAx-Br) and evaluate the evidence of validity in adult general ward patients, extending its application beyond the critical care setting for which it was originally developed. Methods This longitudinal study included 100 adults (57.5 ± 16.7 years; 54% female) consecutively admitted to hospital wards. The CPAx-Br was applied at three time points: within 48 h of admission, alongside the De Morton Mobility Index (DEMMI) and the Global Rating Scale of Change (GRC); 24 h later to assess reliability; and at hospital discharge, again with the DEMMI and GRC. As part of construct validity, hypothesis testing was performed using Spearman's correlation with the DEMMI. Reliability was tested using the Intraclass Correlation Coefficient (ICC2,1) and Standard Error of Measurement (SEM). Responsiveness was evaluated using ROC curve analysis, effect size (ES), and correlation with external measures. Floor and ceiling effects were also examined. Results The CPAx-Br demonstrated adequate reliability (ICC2,1 = 0.99; 95%CI:0.99–1.00) and measurement error (SEM=0.985). Evidence supporting construct validity was obtained through hypothesis testing, demonstrating a positive correlation with the DEMMI (r = 0.895; p < 0.001). Internal responsiveness was low (ES=0.35), while external met the predefined criterion (r = 0.70; p < 0.001). The CPAx-Br showed acceptable discriminative ability (AUC=0.70; 95% CI 0.54 to 0.85), with no floor effect (0%), whereas the ceiling effect was 16%. Conclusion The CPAx-Br demonstrated validity based on hypothesis testing, as well as good reliability and acceptable responsiveness for assessing physical function among adult ward patients.
