Research: Falling


Sosnoff JJ, Socie MJ, Boes MK, Sandroff BM, Pula JH, Suh Y, Weikert M, Balantrapu S, Morrison S, Motl RW. Mobility, balance and falls in persons with multiple sclerosis PLoS One. 2011;6(11):e28021. Epub 2011 .

BACKGROUND: There is a lack of information concerning the relation between objective measures of gait and balance and fall history in persons with MS (PwMS). This investigation assessed the relation between demographic, clinical, mobility and balance metrics and falls history in persons with multiple sclerosis (MS).

METHODS: 52 ambulatory persons with MS (PwMS) participated in the investigation. All persons provided demographic information including fall history over the last 12 months. Disease status was assessed with Expanded Disability Status Scale (EDSS). Walking speed, coordination, endurance and postural control were quantified with a multidimensional mobility battery.

RESULTS: Over 51% of the participants fell in the previous year with 79% of these people being suffering recurrent falls. Overall, fallers were older, had a greater prevalence of assistive devices use, worse disability, decreased walking endurance, and greater postural sway velocity with eyes closed compared to non-fallers. Additionally, fallers had greater impairment in cerebellar, sensory, pyramidal, and bladder/bowel subscales of the EDSS.

CONCLUSIONS:The current observations suggest that PwMS who are older, more disabled, utilize an assistive device, have decreased walking coordination and endurance and have diminished balance have fallen in the previous year. This suggests that individuals who meet these criteria need to be carefully monitored for future falls. The utility of interventions aimed at reducing falls and fall risk in PwMS needs to be established.

Although I suspect you could guess as much about the conclusions, in response to the final statement another new study shows

Matsuda PN, Shumway-Cook A, Ciol MA, Bombardier CH, Kartin DA. Understanding Falls in Multiple Sclerosis: Association of Mobility Status, Concerns About Falling, and Accumulated Impairments Phys Ther. 2011 [Epub]

Background: Falls among persons with multiple sclerosis (MS) are a serious health concern and the percentage of people restricting activity due to concerns about falls is not known. Mobility function and accumulated impairments are associated with fall risk in older adults but not in stroke, and have not been studied in MS.

Objective: The purposes of this study were: (1) to estimate the percentage of people with MS reporting falls, concerns about falling (CAF), and fall related activity restrictions; (2) to examine the association among these factors and fall status; and (3) to explore the association of fall status with mobility function and number of accumulated impairments.

METHODS: 575 community-dwelling people with MS provided information about sociodemographics, falls, CAF and related activity restriction, mobility function, and accumulated impairments. Chi-square statistics explored the association among these factors.

RESULTS: Among all participants, 61% reported concerns about falling and 67% reported CAF-related activity-restriction. Among non-fallers, 25.9% reported CAF and 27.7% reported CAF-related activity restriction.

Mobility function was associated with fall status (P < 0.001 = One in a thousand chance that these results occur by chance i.e. are un-related. Therefore this result indicates that mobility function and fall status are related to one another); people reporting moderate mobility restrictions reported the highest percentage of falls and non-walkers reported the lowest percentage. Falls were associated with accumulated impairments (P< 0.001), with the highest percentage of those with 10 impairments reporting 2 or more falls.

Limitations: This cross-sectional study relied on self-reported falls, mobility, and impairment status, not objectively verified.

CONCLUSIONS: Concerns about falling and Concerns about falling-related activity restriction are common in persons with MS and were reported by fallers and non-fallers. The association between fall status and mobility function is not linear. Fall risk increases with declining mobility function, but at a certain threshold, further declines were associated with reduced falls, possibly due to reduced fall risk-exposure.

This study does not need analysis as it is self-explanitory, but if you are worried about the risk of a fall, take note you are not alone

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