Barts-MS rose-tinted-odometer: ★★ (A Green & Yellow Friday – Lime Green (#32CC32) & Lemon Glacier (#F4FF00))
The biggest risk of losing your independence is falling and long bone fractures of the lower limbs. PwMS are 6x more likely than the general population to fall and fracture a lower limb long bone. I currently have a patient of mine with PPMS in hospital with bilateral fractures of the femur. She will not walk again.
In our experience, the best predictor of falling is the need for a walking aid. The study below shows that fallers are more likely to have progressive or advanced MS and are already less mobile.
Please, please, please if you are tripping, having near falls or have fallen please get yourself referred to a falls prevention clinic and to see a physiotherapist. There are a lot of things that can be done to prevent falls.
Another issue is bone health. Faller or near fallers need to have their bone density checked and treated if low. The majority of pwMS have osteopenia and need to be on medication to manage this problem. The reason why pwMS have thin bones is well known; less vitamin D, less sunlight, less physical activity, higher rate of smoking, intermittent steroids, etc.
Prevention of falls and fractures is better than treating their consequences. I will do a separate MS-Selfie Newsletter on falls prevention.
Block et al. Identifying falls remotely in people with multiple sclerosis. J Neurol. 2021 Aug 17;1-10. doi: 10.1007/s00415-021-10743-y.
Background: Falling is common in people with multiple sclerosis (MS) but tends to be under-ascertained and under-treated.
Objective: To evaluate fall risk in people with MS.
Methods: Ninety-four people with MS, able to walk > 2 min with or without an assistive device (Expanded Disability Status Scale (EDSS ≤ 6.5) were recruited. Clinic-based measures were recorded at baseline and 1 year. Patient-reported outcomes (PROs), including a fall survey and the MS Walking Scale (MSWS-12), were completed at baseline, 1.5, 3, 6, 9, and 12 months. Average daily step counts (STEPS) were recorded using a wrist-worn accelerometer.
Results: 50/94 participants (53.2%) reported falling at least once. Only 56% of participants who reported a fall on research questionnaires had medical-record documented falls. Fallers had greater disability [median EDSS 5.5 (IQR 4.0-6.0) versus 2.5 (IQR 1.5-4.0), p < 0.001], were more likely to have progressive MS (p = 0.003), and took fewer STEPS (mean difference – 1,979, p = 0.007) than Non-Fallers. Stepwise regression revealed MSWS-12 as a major predictor of future falls.
Conclusions: Falling is common in people with MS, under-reported, and under-ascertained by neurologists in clinic. Multimodal fall screening in clinic and remotely may help improve patient care by identifying those at greatest risk, allowing for timely intervention and referral to specialized physical rehabilitation.
General Disclaimer: Please note that the opinions expressed here are those of Professor Giovannoni and do not necessarily reflect the positions of the Barts and The London School of Medicine and Dentistry nor Barts Health NHS Trust and are not meant to be interpreted as personal clinical advice.