Falls in people with MS--an individual data meta-analysis from studies from Australia, Sweden, United Kingdom and the United States

Y Nilsagård, H Gunn, J Freeman, P Hoang, S Lord, Rajarshi Mazumder, Michelle Cameron, Y Nilsagård, H Gunn, J Freeman, P Hoang, S Lord, Rajarshi Mazumder, Michelle Cameron

Abstract

Background: Falls are common in people with multiple sclerosis (PwMS). Previous studies have generally included small samples and had varied methods.

Objectives: The objectives of this paper are to compile fall rates across a broad range of ages and disease severity and to definitively assess the extent to which MS-associated and demographic factors influence fall rates.

Methods: Individual data from studies in four countries that prospectively measured falls for three months were analyzed. We determined fall rates, prevalence of fallers (≥1 falls) and frequent fallers (≥2 falls), location and timing of falls, and fall-related demographic factors.

Results: A total of 537 participants reported 1721 falls: 56% were fallers and 37% frequent fallers. Most falls occurred indoors (65%) between 6 a.m. and 6 p.m. (75%). Primary progressive MS was associated with significantly increased odds of being a faller (odds ratio (OR) 2.02; CI 1.08-3.78). Fall risk peaked at EDSS levels of 4.0 and 6.0 with significant ORs between 5.30 (2.23-12.64) and 5.10 (2.08-12.47). The fall rate was lower in women than men (relative risk (RR) 0.80; CI 0.67-0.94) and decreased with increasing age (RR 0.97 for each year, CI 0.95-0.98).

Conclusion: PwMS are at high risk of falls and there are important associations between falls and MS-associated disability, gender and age.

Keywords: Accidental falls; cohort studies; meta-analysis; multiple sclerosis; risk factors.

Conflict of interest statement

Conflicts of interest: None declared.

© The Author(s), 2015.

Figures

Figure 1.
Figure 1.
Association between EDSS and risk of being classified as a faller (≥1 fall, unadjusted OR). EDSS: Expanded Disability Status Scale; OR: odds ratio.

References

    1. Bazelier MT, de Vries F, Bentzen J, et al. Incidence of fractures in patients with multiple sclerosis: The Danish National Health Registers. Mult Scler 2012; 18: 622–627.
    1. Cameron MH, Poel AJ, Haselkorn JK, et al. Falls requiring medical attention among veterans with multiple sclerosis: A cohort study. J Rehabil Res Dev 2011; 48: 13–20.
    1. Matsuda PN, Shumway-Cook A, Bamer AM, et al. Falls in multiple sclerosis. PM R 2011; 3: 624–632; quiz 632.
    1. Matsuda PN, Shumway-Cook A, Ciol MA, et al. Understanding falls in multiple sclerosis: Association of mobility status, concerns about falling, and accumulated impairments. Phys Ther 2012; 92: 407–415.
    1. Peterson EW, Cho CC, Finlayson ML. Fear of falling and associated activity curtailment among middle aged and older adults with multiple sclerosis. Mult Scler 2007; 13: 1168–1175.
    1. Peterson EW, Cho CC, von Koch L, et al. Injurious falls among middle aged and older adults with multiple sclerosis. Arch Phys Med Rehabil 2008; 89: 1031–1037.
    1. Cameron MH, Horak FB, Herndon RR, et al. Imbalance in multiple sclerosis: A result of slowed spinal somatosensory conduction. Somatosens Mot Res 2008; 25: 113–122.
    1. Cattaneo D, De Nuzzo C, Fascia T, et al. Risks of falls in subjects with multiple sclerosis. Arch Phys Med Rehabil 2002; 83: 864–867.
    1. Coote S, Hogan N, Franklin S. Falls in people with multiple sclerosis who use a walking aid: Prevalence, factors, and effect of strength and balance interventions. Arch Phys Med Rehabil 2013; 94: 616–621.
    1. Finlayson ML, Peterson EW, Cho CC. Risk factors for falling among people aged 45 to 90 years with multiple sclerosis. Arch Phys Med Rehabil 2006; 87: 1274–1279.
    1. Gunn H, Creanor S, Haas B, et al. Risk factors for falls in multiple sclerosis: An observational study. Mult Scler 2013; 19: 1913–1922.
    1. Hoang PD, Cameron MH, Gandevia SC, et al. Neuropsychological, balance, and mobility risk factors for falls in people with multiple sclerosis: A prospective cohort study. Arch Phys Med Rehabil 2014; 95: 480–486.
    1. Nilsagard Y, Lundholm C, Denison E, et al. Predicting accidental falls in people with multiple sclerosis—a longitudinal study. Clin Rehabil 2009; 23: 259–269.
    1. Peterson EW, Ben Ari E, Asano M, et al. Fall attributions among middle-aged and older adults with multiple sclerosis. Arch Phys Med Rehabil 2013; 94: 890–895.
    1. Prosperini L, Kouleridou A, Petsas N, et al. The relationship between infratentorial lesions, balance deficit and accidental falls in multiple sclerosis. J Neurol Sci 2011; 304: 55–60.
    1. Ytterberg C, Einarsson U, Holmqvist LW, et al. A population-based study of fall risk factors among people with multiple sclerosis in Stockholm county. J Rehabil Med 2013; 45: 452–457.
    1. Gunn HJ, Newell P, Haas B, et al. Identification of risk factors for falls in multiple sclerosis: A systematic review and meta-analysis. Phys Ther 2013; 93: 504–513.
    1. Finlayson ML, Peterson EW, Asano M. A cross-sectional study examining multiple mobility device use and fall status among middle-aged and older adults with multiple sclerosis. Disabil Rehabil Assist Technol 2014; 9: 12–16.
    1. Peterson EW, Ben Ari E, Asano M, et al. Fall attributions among middle-aged and older adults with multiple sclerosis. Arch Phys Med Rehabil 2013; 94: 890–895.
    1. Cameron MH, Asano M, Bourdette D, et al. People with multiple sclerosis use many fall prevention strategies but still fall frequently. Arch Phys Med Rehabil 2013; 94: 1562–1566.
    1. Kasser SL, Jacobs JV, Foley JT, et al. A prospective evaluation of balance, gait, and strength to predict falling in women with multiple sclerosis. Arch Phys Med Rehabil 2011; 92: 1840–1846.
    1. Prosperini L, Fortuna D, Gianni C, et al. The diagnostic accuracy of static posturography in predicting accidental falls in people with multiple sclerosis. Neurorehabil Neural Repair 2013; 27: 45–52.
    1. Lamb SE, Jorstad-Stein EC, Hauer K, et al. Development of a common outcome data set for fall injury prevention trials: The Prevention of Falls Network Europe consensus. J Am Geriatr Soc 2005; 53: 1618–1622.
    1. van Vliet R, Hoang P, Lord S, et al. Falls efficacy Scale-International: A cross-sectional validation in people with multiple sclerosis. Arch Phys Med Rehabil 2013; 94: 883–889.
    1. Poser CM, Paty DW, Scheinberg L, et al. New diagnostic criteria for multiple sclerosis: Guidelines for research protocols. Ann Neurol 1983; 13: 227–231.
    1. Polman CH, Reingold SC, Banwell B, et al. Diagnostic criteria for multiple sclerosis: 2010 revisions to the McDonald criteria. Ann Neurol 2011; 69: 292–302.
    1. Kurtzke JF. Rating neurologic impairment in multiple sclerosis: An Expanded Disability Status Scale (EDSS). Neurology 1983; 33: 1444–1452.
    1. Hohol MJ, Orav EJ, Weiner HL. Disease steps in multiple sclerosis: A simple approach to evaluate disease progression. Neurology 1995; 45: 251–255.
    1. Lechner-Scott J, Kappos L, Hofman M, et al. Can the Expanded Disability Status Scale be assessed by telephone? Mult Scler 2003; 9: 154–159.
    1. Liquet B, Commenges D. Correction of the P-value after multiple coding of an explanatory variable in logistic regression. Stat Med 2001; 20: 2815–2826.
    1. Coote S, Finlayson M, Sosnoff JJ. Level of mobility limitations and falls status in persons with multiple sclerosis. Arch Phys Med Rehabil 2014; 95: 862–866.
    1. Twork S, Wiesmeth S, Spindler M, et al. Disability status and quality of life in multiple sclerosis: Non-linearity of the Expanded Disability Status Scale (EDSS). Health Qual Life Outcomes 2010; 8: 55.
    1. Kelsey JL, Berry SD, Procter-Gray E, et al. Indoor and outdoor falls in older adults are different: The maintenance of balance, independent living, intellect, and Zest in the Elderly of Boston Study. J Am Geriatr Soc 2010; 58: 2135–2141.
    1. Motl RW, McAuley E, Sandroff BM. Longitudinal change in physical activity and its correlates in relapsing–remitting multiple sclerosis. Phys Ther 2013; 93: 1037–1048.
    1. Cameron MH, Nilsagard YE. Measurement and treatment of imbalance and fall risk in multiple sclerosis using the International Classification of Functioning, Disability and Health model. Phys Med Rehabil Clin N Am 2013; 24: 337–354.

Source: PubMed

Sponsorer og samarbejdspartnere

Medicinske tilstande

Narkotikainterventioner

3
Abonner