Clinical Predictors of Falls in Ambulatory Activity in MS: 6-Month Prospective Study.
|Title||Clinical Predictors of Falls in Ambulatory Activity in MS: 6-Month Prospective Study.|
|Publication Type||Journal Article|
|Authors||Wundes A, Brown TR, Severson BJ, Bowen JD|
|Journal||International Journal of Clinical and Experimental Hypnosis|
Background: Falling is a frequent cause of morbidity in multiple sclerosis (MS), and health care providers need simple clinical methods that identify patients at risk for falls. This is a preliminary report of a 6-month prospective study of ambulatory MS patients to evaluate the association of four clinical tests and two questionnaires with ambulatory activity and falls in the MS community performed at the MS Center Evergreen. Methods: Forty subjects with definite MS, ages 18–70 years, Expanded Disability Status Scale (EDSS) scores of 0–6.5, and stable disease are being enrolled. Participants are assessed three times in clinic with EDSS, Hauser Ambulation Index, Berg Balance Test, Lower-Extremity Motor Coordination Test, self-report questionnaires, the MS Walking Scale, and Modified Fatigue Impact Scale. Ambulatory activity is recorded by ankle-worn accelerometers (StepWatch3) for 1 week during Months 1 and 6. Falls and near-falls are recorded during the study by diaries and monthly phone monitoring. Results: Twenty-three MS patients have completed the study to date, with a mean EDSS score of 5.0, range 3.0–6.5. Falls were reported by 19 participants during the observation period, with a median fall rate of three during 6 months. Average daily steps per subject ranged from 657 to 12,474 (mean 6656). There was only a weak correlation between falls and ambulatory activity as measured by steps/day. There was a negative correlation between average steps/day and EDSS. Based on preliminary analysis, some correlation between the clinical tests and falls was found, but no single clinical measure or questionnaire appeared strongly correlated with falls. Conclusions: Most MS patients with some disability will fall during a 6-month period. The level of activity may not correlate with the frequency of falls. Our study is exploring the predictive value of validated clinical tests of gait, balance and coordination, and self-assessment questionnaires for falls and ambulatory activity.