Can clinical measures predict falls in multiple sclerosis?

TitleCan clinical measures predict falls in multiple sclerosis?
Publication TypeJournal Article
AuthorsWundes A, Brown TR, Bamer AM, Severson BJ, McAleenan J
JournalInternational Journal of MS Care

Background: Falls are the cause of serious injury and incapacity. Patients with multiple sclerosis (MS) should be screened for their potential to fall so that preventive interventions can be performed for those who are at risk. There is no standard method of clinical assessment for fall risk in MS. We conducted a prospective 6-month study of ambulatory MS patients to evaluate the association of five clinical tests and two questionnaires with falls outcome. Methods: Forty MS patients were assessed twice with the Expanded Disability Status Scale (EDSS), Timed 25-Foot Walk, Hauser Ambulation Index, Berg Balance Test, Lower Extremity Motor Coordination test, MS Walking Scale, and Modified Fatigue Impact Scale (MFIS). Participants were monitored for 6 months by monthly phone visits and falls diaries. We used logistic regression to test how well these measures predicted falling and not falling. Results: Thirty-eight participants (mean age, 55.5 years; mean EDSS score, 2.5–6.5) completed the study. Of these, 26% had no fall, 11% had one fall, and 63% had two or more falls over 6 months. On average, participants had 4.7 falls over the 6-month period. There was no significant correlation between any of five clinical tests or the two self-report questionnaires and falls. However, the MFIS trended toward statistical significance (total score, P = .08; physical subscale, P = .07) much more closely than any of the other measures. Conclusions: Falls were frequently observed in our cohort. They were surprisingly difficult to predict by standardized clinical tests that are commonly used in MS care and research. There is a need to develop better clinical predictors of falls in this patient population. The relationship between fatigue and falls warrants further study.

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