The Mediating Role of Balance in the Relationship Between Fatigue and Fear of Falling in Individuals With Multiple Sclerosis

June 25, 2026 updated by: Uskudar University
Fatigue, balance impairment, and fear of falling are common problems in individuals with Multiple Sclerosis (MS). Previous studies have shown significant associations among these variables; however, the mechanisms underlying the relationship between fatigue and fear of falling remain unclear. It is possible that fatigue increases fear of falling indirectly through its negative effects on balance performance.

Study Overview

Status

Not yet recruiting

Conditions

Intervention / Treatment

Detailed Description

Multiple sclerosis (MS) is a chronic demyelinating and neurodegenerative disease of the central nervous system that frequently leads to fatigue, balance impairment, and fear of falling. These symptoms negatively affect mobility, independence, participation in daily activities, and quality of life. Fatigue is one of the most common and disabling symptoms in individuals with MS and may contribute to impaired balance and an increased risk of falls.

Fear of falling is highly prevalent in people with MS and is associated with reduced physical activity, activity avoidance, and functional decline. Balance impairment is another common manifestation of MS and may represent an important mechanism linking fatigue to fear of falling. However, although fatigue, balance, and fear of falling have been investigated separately, the mediating role of balance in the relationship between fatigue and fear of falling has not been sufficiently explored.

The aim of this cross-sectional observational study is to investigate whether balance mediates the relationship between fatigue and fear of falling in individuals with multiple sclerosis. Fatigue will be assessed using the Fatigue Severity Scale (FSS), balance performance will be evaluated using the Mini-Balance Evaluation Systems Test (Mini-BESTest), and fear of falling will be measured using the Falls Efficacy Scale-International (FES-I).

The findings of this study are expected to improve the understanding of the mechanisms underlying fear of falling in individuals with MS and provide evidence to support the development of rehabilitation programs targeting balance to reduce fear of falling and improve functional outcomes.

Study Type

Observational

Enrollment (Estimated)

40

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Contact

Study Contact Backup

Study Locations

  • Turkey (Türkiye)
    • Üsküdar
      • Istanbul, Üsküdar, Turkey (Türkiye), 34662
        • Uskudar University
        • Contact:

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

  • Adult
  • Older Adult

Accepts Healthy Volunteers

N/A

Sampling Method

Non-Probability Sample

Study Population

The study population will consist of adults diagnosed with multiple sclerosis who are clinically stable and able to complete the study assessments. Eligible participants will be recruited from the outpatient neurology and physical medicine and rehabilitation clinics of Başkent University.

Description

Inclusion Criteria:

  • Age 18-65 years
  • Neurologist-confirmed MS diagnosis
  • No relapse within the previous 30 days
  • Ability to walk independently or with an assistive device
  • Ability to understand instructions
  • Voluntary participation

Exclusion Criteria:

  • Recent MS relapse
  • Severe vestibular disorder
  • Other neurological diseases
  • Severe orthopedic conditions affecting mobility
  • Recent lower extremity surgery or trauma
  • Cardiopulmonary conditions limiting assessment

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

Cohorts and Interventions

Group / Cohort
Intervention / Treatment
Individuals with Multiple Sclerosis
Adults diagnosed with multiple sclerosis who meet the eligibility criteria will participate in a single assessment session to evaluate fatigue, balance, and fear of falling.
Other: Observational Model: Cross-Sectional
Observational Model: Cross-Sectional

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Falls Efficacy Scale-International
Time Frame: Time Frame: Baseline (single assessment)
Fear of falling will be assessed using the Falls Efficacy Scale-International (FES-I). The FES-I is a 16-item questionnaire that evaluates concern about falling during a range of daily activities. Total scores range from 16 to 64, with higher scores indicating greater fear of falling.
Time Frame: Baseline (single assessment)

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Fatigue Severity Scale (FSS)
Time Frame: Baseline (single assessment)
Fatigue severity will be assessed using the Fatigue Severity Scale (FSS). The FSS consists of 9 items rated on a 7-point Likert scale. The total score is calculated as the mean of all items, with higher scores indicating greater fatigue severity.
Baseline (single assessment)
Baseline (single assessment)
Time Frame: Baseline (single assessment)
Balance performance will be evaluated using the Mini-Balance Evaluation Systems Test (Mini-BESTest). The Mini-BESTest consists of 14 items assessing dynamic balance. Total scores range from 0 to 28, with higher scores indicating better balance performance.
Baseline (single assessment)

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Uskudar University

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Estimated)

July 1, 2026

Primary Completion (Estimated)

July 20, 2026

Study Completion (Estimated)

July 25, 2026

Study Registration Dates

First Submitted

June 25, 2026

First Submitted That Met QC Criteria

June 25, 2026

First Posted (Actual)

July 1, 2026

Study Record Updates

Last Update Posted (Actual)

July 1, 2026

Last Update Submitted That Met QC Criteria

June 25, 2026

Last Verified

June 1, 2026

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • Uskudar-MS

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

NO

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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