Musculoskeletal dysfunction in chronic obstructive pulmonary disease (COPD): An observational study

Background/Aims: Chronic obstructive pulmonary disease (COPD) is widely recognised as a multisystem disease that extends beyond the lung and can further impair functional capacity, including that of the musculoskeletal system. While it has been reported that these changes may contribute to exercise limitation and disability, there has been little research to describe the nature and extent of changes in the musculoskeletal system. Therefore, the aim of this study was to examine differences in posture, joint mobility and muscle sensitivity in subjects with COPD compared with a matched group of healthy subjects. A secondary aim was to explore whether a relationship exists between pulmonary function and musculoskeletal changes. Finally, the data were used to evaluate whether an association exists between cervicothoracic posture, joint mobility and muscle sensitivity, and having diagnosed COPD. Methods: A prospective observational study was reported in accordance with Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines. Participants with stable COPD (n=33; mean±SD age: 67 ± 9 years; FEV1% predicted: 50.94 ±19.40%) and age-matched controls (n=55; mean±SD age: 67 ± 6 years; FEV1% predicted: 104.53 ±16.86%) were recruited from primary and secondary care sources. Pulmonary function and performance-based outcome measures (predictors) included posture, spinal joint mobility, and accessory respiratory muscle sensitivity. Sociodemographic data and confounding variables were assessed using questionnaires and performance-based measures. Results: Reduced thoracic (p<0.001, 95%CI –21.64, –8.86) and cervical spine rotation (p=0.01, 95%CI –25.57, –3.33), altered cervicothoracic posture and heightened sensitivity in accessory muscles (p=0.01, 95% CI –601.81,–97.31) of respiration were found in the COPD population. Reduced thoracic axial rotation and altered neck posture were associated with poorer pulmonary function (p<0.05) and having diagnosed COPD, with odds ratios of 0.90 (0.84, 0.97) and 1.15 (1.02, 1.29), respectively. Conclusions: This is the first study to examine musculoskeletal changes in patients with COPD. The results show that musculoskeletal changes are evident in the cervicothoracic region and may contribute to exercise limitation and disability reported in this patient population.