Utility of Disease-Specific Measures and Clinical Balance Tests in Prediction of Falls in Persons With Multiple Sclerosis.
Dibble LE, Lopez-Lennon C, Lake W, Hoffmeister C, Gappmaier E.
J Neurol Phys Ther. 2013 Jul 18. [Epub ahead of print]

BACKGROUND AND PURPOSE: The sensory and motor deficits associated with multiple sclerosis (MS) contribute to falls with the majority of persons with MS falling at least once annually. To appropriately direct treatment, accurate fall prediction measures are needed. In this study of community-dwelling individuals with MS followed for 12 months, we sought to determine frequency of falls, utility of clinical balance tests to predict falls, and accuracy of participants’ retrospective recall of fall events.
METHODS: Independently ambulatory persons with MS underwent 5 clinical balance tests including Activities-specific Balance Confidence, Berg Balance Scale, Functional Reach, Timed Up and Go, and Dynamic Gait Index, and one disease-specific measure of disability (Expanded Disability Status Scale) and then were followed for 1 year. Participants were queried monthly by phone to determine the number of fall events that had occurred. Accuracy of fall prediction was determined by receiver operating characteristic curve analysis and comparison of balance test performance between fallers and nonfallers.
RESULTS: Sixty-one percent of the 38 participants were classified as fallers at 12-month follow-up. Only the Berg Balance Scale, Dynamic Gait Index, and the Activities-specific Balance Confidence demonstrated clinically useful levels of accuracy. In addition, participants were generally poor in their accurate recall of fall events relative to their monthly fall reports.
DISCUSSION AND CONCLUSIONS: The majority of participants fell during a 1-year prospective follow-up. Only 2 balance performance measures and 1 balance confidence measure accurately distinguished between fallers and nonfallers as well as possessed clinically useful levels of sensitivity and specificity. These results also emphasized the inaccuracy of retrospective fall history in an MS sample.

Falls are a major problem for people with MS. There is evidence that people with MS don’t tell their neurologist when they are falling; I presume that this at least in part due to a feeling that there isn’t much that we can do about this. Also, I wonder if there is concern that admitting to falling would lead to having to use a walking aid – something that a number of people are keen to avoid if at all possible. If I’m totally wide of the mark on this then please comment!
The authors of this paper set out to study how good tests designed to give an estimate of falls risk actually are. These tests are not new; and they have previously been validated for falls prediction in MS. The Berg Balance Scale and Dynamic Gait Index involve an observer rating people on how good their balance is carrying out certain tasks, whereas the Activities-Specific Balance Confidence scale is a self-report measure, where people report their confidence in carrying out certain activities. 
The results of this study are not surprising, in that these tests do give an indication of falls risk. However, what is interesting is that people tend to be poor at recalling falls. What is really needed is a way of predicting falls before they start happening, in order to enable interventions to prevent falls. 

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