Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2023 Nov 22;32(170):230134.
doi: 10.1183/16000617.0134-2023. Print 2023 Dec 31.

Investigating the prognostic value of digital mobility outcomes in patients with chronic obstructive pulmonary disease: a systematic literature review and meta-analysis

Sara C Buttery  1   2 , Parris J Williams  3   2 , Saeed M Alghamdi  4 , Keir E J Philip  3   2 , Alexis Perkins  3   2 , Constantinos Kallis  3 , Jennifer K Quint  3 , Michael I Polkey  3   2 , Sofie Breuls  5   6 , Joren Buekers  7   8   9 , Nikolaos Chynkiamis  10   11 , Laura Delgado-Ortiz  7   8   9 , Heleen Demeyer  5   6 , Anja Frei  12 , Judith Garcia-Aymerich  7   8   9 , Elena Gimeno-Santos  7   8   9 , Sarah Koch  7   8   9 , Dimitrios Megaritis  10 , Ashley Polhemus  11 , Thierry Troosters  5   6 , Ioannis Vogiatzis  12   10 , Henrik Watz  13 , Nicholas S Hopkinson  3   2
Affiliations
Meta-Analysis

Investigating the prognostic value of digital mobility outcomes in patients with chronic obstructive pulmonary disease: a systematic literature review and meta-analysis

Sara C Buttery et al. Eur Respir Rev. .

Abstract

Background: Reduced mobility is a central feature of COPD. Assessment of mobility outcomes that can be measured digitally (digital mobility outcomes (DMOs)) in daily life such as gait speed and steps per day is increasingly possible using devices such as pedometers and accelerometers, but the predictive value of these measures remains unclear in relation to key outcomes such as hospital admission and survival.

Methods: We conducted a systematic review, nested within a larger scoping review by the MOBILISE-D consortium, addressing DMOs in a range of chronic conditions. Qualitative and quantitative analysis considering steps per day and gait speed and their association with clinical outcomes in COPD patients was performed.

Results: 21 studies (6076 participants) were included. Nine studies evaluated steps per day and 11 evaluated a measure reflecting gait speed in daily life. Negative associations were demonstrated between mortality risk and steps per day (per 1000 steps) (hazard ratio (HR) 0.81, 95% CI 0.75-0.88, p<0.001), gait speed (<0.80 m·s-1) (HR 3.55, 95% CI 1.72-7.36, p<0.001) and gait speed (per 1.0 m·s-1) (HR 7.55, 95% CI 1.11-51.3, p=0.04). Fewer steps per day (per 1000) and slow gait speed (<0.80 m·s-1) were also associated with increased healthcare utilisation (HR 0.80, 95% CI 0.72-0.88, p<0.001; OR 3.36, 95% CI 1.42-7.94, p=0.01, respectively). Available evidence was of low-moderate quality with few studies eligible for meta-analysis.

Conclusion: Daily step count and gait speed are negatively associated with mortality risk and other important outcomes in people with COPD and therefore may have value as prognostic indicators in clinical trials, but the quantity and quality of evidence is limited. Larger studies with consistent methodologies are called for.

PubMed Disclaimer

Conflict of interest statement

Conflicts of interest declaration: S.C. Buttery reports educational speaker fees for Pulmonx. J.K. Quint has received grants from the Medical Research Council, the National Institute for Health Data Science (HDR UK), GlaxoSmithKline, Bohringer Ingelheim and Taskforce via Asthma + Lung UK, and AstraZeneca; and personal fees for advisory board participation, consultancy or speaking fees from GlaxoSmithKline, Evidera, AstraZeneca and Insmed. M.I. Polkey reports consultancy for Philips Respironics. J. Garcia-Aymerich reports speaker honoraria from Chiesi and a grant from AstraZeneca paid to her institution for a COVID-19-related project and is also a paid advisory board member for AstraZeneca. A. Polhemus is a paid employee of Merck & Co, Inc. and IQVIA AG. T. Troosters reports a Mobilise-D Innotive Medicines Initiative grant. All other authors report no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
Preferred Reporting of Items for Systematic Reviews and Meta-analyses (PRISMA) flow diagram for updated systematic reviews which included searches of databases, registers and other sources. Reasons for report exclusion are listed in supplementary table S2. One study had records in the original search and update, so there were 21 studies included in total.
FIGURE 2
FIGURE 2
Association between daily step count and all-cause mortality in COPD. Hazard ratios (HRs) are presented with 95% confidence intervals. The red line is the average effect estimate. The black line shows no effect. REML: restricted maximum likelihood.
FIGURE 3
FIGURE 3
Association between a) low gait speed (<0.8 m·s−1) and all-cause mortality in COPD. b) Decline in gait speed (per m·s−1) and all-cause mortality in COPD. Hazard ratios (HRs) are presented with 95% confidence intervals. The red line is the average effect estimate. The black line shows no effect. REML: restricted maximum likelihood.
See this image and copyright information in PMC

References

    1. Musich S, Wang SS, Ruiz J, et al. . The impact of mobility limitations on health outcomes among older adults. Geriatr Nurs 2018; 39: 162–169. doi:10.1016/j.gerinurse.2017.08.002 - DOI - PubMed
    1. Iezzoni LI, McCarthy EP, Davis RB, et al. . Mobility difficulties are not only a problem of old age. J Gen Intern Med 2001; 16: 235–243. doi:10.1046/j.1525-1497.2001.016004235.x - DOI - PMC - PubMed
    1. Saint-Maurice PF, Troiano RP, Bassett DR, Jr, et al. . Association of daily step count and step intensity with mortality among US adults. JAMA 2020; 323: 1151–1160. doi:10.1001/jama.2020.1382 - DOI - PMC - PubMed
    1. Comber L, Galvin R, Coote S. Gait deficits in people with multiple sclerosis: a systematic review and meta-analysis. Gait Posture 2017; 51: 25–35. doi:10.1016/j.gaitpost.2016.09.026 - DOI - PubMed
    1. Creaby MW, Cole MH. Gait characteristics and falls in Parkinson's disease: a systematic review and meta-analysis. Parkinsonism Relat Disord 2018; 57: 1–8. doi:10.1016/j.parkreldis.2018.07.008 - DOI - PubMed