Relationship Between Hamstrings to Quadriceps Strength Ratio and Balance in Chronic Obstructive Pulmonary Disease Patients at Central Chest Clinic, Colombo

Abstract

Background: Chronic Obstructive Pulmonary Disease (COPD) is a progressive respiratory condition that frequently leads to lower limb muscle weakness and compromised balance. The hamstrings-to-quadriceps (H:Q) strength ratio is a crucial clinical measure that significantly contributes to postural stability. However, there is a lack of data regarding the relationship between the H:Q ratio and balance in COPD patients in Sri Lanka. Objectives: To assess the relationship between H:Q ratio and balance among COPD patients at Central Chest Clinic, Colombo Methods: A cross-sectional study was conducted at the Central Chest Clinic, involving 138 COPD patients selected by convenient sampling, aged between 35-75 years. Demographic information was gathered using an interviewer-administered questionnaire. The isometric strength of the quadriceps and hamstrings were measured using a hand-held dynamometer, and the H:Q strength ratios were calculated for both dominant and non-dominant limbs. The Berg Balance Scale (BBS) was employed to assess functional balance. Data analysis was performed using Spearman correlation with SPSS version 25.0. Results: The mean±SD age of the participants was 63.6±6.7 years with a majority of males (n=113, 81.9%). The mean±SD H:Q strength ratio for the dominant and non-dominant sides were 0.65±0.2, while the mean±SD BBS score was 42.6±11.6. A significant positive correlation was observed in the BBS score with the H:Q ratio of dominant (r=0.41, p=0.000) and non-dominant sides (r=0.28, p=0.001). Conclusions: The study revealed a strong positive relationship between H:Q ratio and balance in patients with COPD. This underscores the importance of lower limb muscle strength in maintaining balance. Hence, incorporating strength training exercises for the hamstrings and quadriceps into pulmonary rehabilitation could enhance balance in this population.