Citation

Hoang PD, Cameron MH, Gandevia SC, Lord SR. Arch. Phys. Med. Rehabil. 2014; 95(3): 480-486.

Affiliation

Neuroscience Research Australia, University of New South Wales, Randwick, Sydney, Australia.

Copyright

(Copyright © 2014, Elsevier Publishing)

DOI

10.1016/j.apmr.2013.09.017

PMID

24096187

Abstract

OBJECTIVES: To determine whether impaired performance in a range of vision, proprioception, neuropsychological, balance and mobility tests, and pain and fatigue, are associated with falls in people with multiple sclerosis (PwMS). DESIGN: Prospective cohort study with 6-month follow-up. SETTING: An MS physiotherapy clinic in Australia. PARTICIPANTS: 210 community-dwelling people (21-74 years) with MS (Disease Steps 0-5). INTERVENTIONS: Not applicable MAIN OUTCOME MEASURES: Incidence of falls during 6 months follow up. RESULTS: In the six months follow-up period, 83 participants (39.7%) experienced no falls, 57 (27.3%) fell once or twice and 69 (33.0%) fell three or more times. Frequent falling (3+) was associated with increased postural sway (eyes open and closed), poor leaning balance (as assessed with the coordinated stability task), slow choice stepping reaction time, reduced walking speed, reduced executive functioning (as assessed with the TMT B-A test), reduced fine motor control (performance on the 9-hole peg test) and reported leg pain. Increased sway with the eyes closed, poor coordinated stability and reduced performance in the 9-hole peg test were identified as variables that significantly and independently discriminated between frequent fallers and non-frequent fallers (Model χ2=30.1, df=3, p<0.001). The area under the ROC curve for this model was 0.712 (95% CI = 0.638 - 0.785). CONCLUSIONS: The study reveals important balance, coordination and cognitive determinants of falls in PwMS. These should assist the development of effective strategies for prevention of falls in this high-risk group.

Language: en