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Risk factors for falls in multiple sclerosis: an observational study.
Gunn H, Creanor S, Haas B, Marsden J, Freeman J.
School of Health Professions, Plymouth University, UK.
BACKGROUND: People with multiple sclerosis (MS) experience frequent falls, which
are associated with impairments and limitations to activities and participations.
OBJECTIVE: The objective of this paper is to evaluate falls risk factors using
robust clinical measures.
METHODS: A total of 150 individuals (confirmed MS
diagnosis, Expanded Disability Status Scale (EDSS) 3.5-6.5) were recruited, with
148 participants included in the final analysis. Demographic data were collected
and performance assessed in eight predictor measures (Physiological Profile
Assessment (PPA), Brief Ataxia Rating scale, Ashworth scale (Ashworth), Modified
Falls Efficacy scale, Symbol Digit Modalities Test, dual-task interference,
lying/standing blood pressure, static/dynamic visual acuity). Participants
prospectively recorded falls over three months using a daily diary. People were
classified as "fallers" based on reports of ≥ two falls.
RESULTS: A total of 104
participants recorded 672 falls; 78 (52.7%) reported ≥ two falls. Continence
issues, previous falls history and use of prescribed medications were each
associated with increased risk of being a "faller". Ashworth and PPA risk score
contributed significantly to a logistic regression model predicting
faller/non-faller classification. The reduced model (Ashworth, PPA, EDSS) showed
fair-to-good predictive ability (ROC c-statistic 0.73, sensitivity 70%,
specificity 69%).
CONCLUSION: This study confirms the high prevalence of falls in
ambulant people with MS. Important potentially modifiable risk factors are
identified, suggesting aspects to target in falls interventions.
Gunn H, Creanor S, Haas B, Marsden J, Freeman J.
School of Health Professions, Plymouth University, UK.
BACKGROUND: People with multiple sclerosis (MS) experience frequent falls, which
are associated with impairments and limitations to activities and participations.
OBJECTIVE: The objective of this paper is to evaluate falls risk factors using
robust clinical measures.
METHODS: A total of 150 individuals (confirmed MS
diagnosis, Expanded Disability Status Scale (EDSS) 3.5-6.5) were recruited, with
148 participants included in the final analysis. Demographic data were collected
and performance assessed in eight predictor measures (Physiological Profile
Assessment (PPA), Brief Ataxia Rating scale, Ashworth scale (Ashworth), Modified
Falls Efficacy scale, Symbol Digit Modalities Test, dual-task interference,
lying/standing blood pressure, static/dynamic visual acuity). Participants
prospectively recorded falls over three months using a daily diary. People were
classified as "fallers" based on reports of ≥ two falls.
RESULTS: A total of 104
participants recorded 672 falls; 78 (52.7%) reported ≥ two falls. Continence
issues, previous falls history and use of prescribed medications were each
associated with increased risk of being a "faller". Ashworth and PPA risk score
contributed significantly to a logistic regression model predicting
faller/non-faller classification. The reduced model (Ashworth, PPA, EDSS) showed
fair-to-good predictive ability (ROC c-statistic 0.73, sensitivity 70%,
specificity 69%).
CONCLUSION: This study confirms the high prevalence of falls in
ambulant people with MS. Important potentially modifiable risk factors are
identified, suggesting aspects to target in falls interventions.
). I fell once at the bottom of a staircase in 2010, and escaped with just a bruise.
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