Falls in people with multiple sclerosis compared with falls in healthy controls

Rajarshi Mazumder, Charles Murchison, Dennis Bourdette, Michelle Cameron, Rajarshi Mazumder, Charles Murchison, Dennis Bourdette, Michelle Cameron

Abstract

Objective: To compare the risk, circumstances, consequences and causes of prospectively recorded falls between people with multiple sclerosis (PwMS) and healthy controls of similar age and gender.

Methods: 58 PwMS and 58 healthy controls, who are community-dwelling, were recruited in this 6-month prospective cohort study. 90% of PwMS and 84% of healthy controls completed the study. Participants counted falls prospectively using fall calendars and noted fall location, fall-related injuries, and the cause of the falls. Kaplan Meier survival analysis and log-rank tests were performed to compare the distributions of survival without falling between PwMS and healthy controls.

Results: 40.8% of controls and 71.2% of PwMS fell at least once. 48.1% of PwMS and 18.4% of healthy controls fell at least twice. 42.3% of PwMS and 20.4% of health controls sustained a fall-related injury. After adjusting for age and gender, the time to first fall (HR: 1.87, p = 0.033) and the time to recurrent falls (HR: 2.87, p = 0.0082) were significantly different between PwMS and healthy controls. PwMS reported an almost equal number of falls inside and outside, 86% of the falls in healthy controls were outside. Healthy controls were more likely to fall due to slipping on a slippery surface (39.5% vs 10.4%). PwMS more often attributed falls to distraction (31% vs 7%) and uniquely attributed falls to fatigue or heat.

Conclusions: Fall risk, circumstances, consequences, and causes are different for PwMS than for healthy people of the same age and gender. PwMS fall more, are more likely to be injured by a fall, and often fall indoors. PwMS, but not healthy controls, frequently fall because they are distracted, fatigued or hot.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1. Participant flow diagram.
Figure 1. Participant flow diagram.
Figure 2. Frequency of falls in participants…
Figure 2. Frequency of falls in participants with MS and healthy controls.
(A) in participants with MS (n = 52, No falls in 28.8%, 1 fall in 23.1%, 2 falls in 9.6% and 3–10 falls in 34.6%); (B) in healthy controls (n = 49, No falls in 57.1%, 1 fall in 24.5%, 2 falls in 8.2%, 3–10 falls in 8.2%).
Figure 3. Kaplan-Meier survival curves for A)…
Figure 3. Kaplan-Meier survival curves for A) Time to first fall, and B) Time to recurrent falls in people with MS and healthy controls.

References

    1. Cattaneo D, De Nuzzo C, Fascia T, Macalli M, Pisoni I, et al. (2002) Risks of falls in subjects with multiple sclerosis. Arch Phys Med Rehabil 83: 864–867.
    1. Finlayson ML, Peterson EW, Cho CC (2006) Risk factors for falling among people aged 45 to 90 years with multiple sclerosis. Arch Phys Med Rehabil 87: 1274–1279.
    1. Gunn H, Creanor S, Haas B, Marsden J, Freeman J (2014) Frequency, characteristics and consequences of falls in multiple sclerosis: Findings from a cohort study. Arch Phys Med Rehabil 95: 538–45.
    1. Hoang PD, Cameron MH, Gandevia SC, Lord SR (2014) Neuropsychological, balance, and mobility risk factors for falls in people with multiple sclerosis: A prospective cohort study. Arch Phys Med Rehabil 95: 480–6.
    1. Matsuda PN, Shumway-Cook A, Bamer AM, Johnson SL, Amtmann D, et al. (2011) Falls in multiple sclerosis. PM R 3: 624–32.
    1. Nilsagard Y, Lundholm C, Denison E, Gunnarsson LG (2009) Predicting accidental falls in people with multiple sclerosis – a longitudinal study. Clin Rehabil 23: 259–269.
    1. Peterson EW, Cho CC, von Koch L, Finlayson ML (2008) Injurious falls among middle aged and older adults with multiple sclerosis. Arch Phys Med Rehabil 89: 1031–1037.
    1. Koch-Henriksen N, Bronnum-Hansen H, Stenager E (1998) Underlying cause of death in danish patients with multiple sclerosis: Results from the danish multiple sclerosis registry. J Neurol Neurosurg Psychiatry 65: 56–59.
    1. Peterson EW, Cho CC, Finlayson ML (2007) Fear of falling and associated activity curtailment among middle aged and older adults with multiple sclerosis. Mult Scler 13: 1168–1175.
    1. Ganz DA, Bao Y, Shekelle PG, Rubenstein LZ (2007) Will my patient fall? JAMA 297: 77–86.
    1. Sosnoff JJ, Socie MJ, Boes MK, Sandroff BM, Pula JH, et al. (2011) Mobility, balance and falls in persons with multiple sclerosis. PLoS One 6: e28021.
    1. Cameron MH, Poel AJ, Haselkorn JK, Linke A, Bourdette D (2011) Falls requiring medical attention among veterans with multiple sclerosis: A cohort study. J Rehabil Res Dev 48: 13–20.
    1. Polman CH, Reingold SC, Edan G, Filippi M, Hartung HP, et al. (2005) Diagnostic criteria for multiple sclerosis: 2005 revisions to the “McDonald criteria”. Ann Neurol 58: 840–846.
    1. Kurtzke JF (1983) Rating neurologic impairment in multiple sclerosis: An expanded disability status scale (EDSS). Neurology 33: 1444–1452.
    1. Lamb SE, Jorstad-Stein EC, Hauer K, Becker C, Prevention of Falls Network Europe and Outcomes Consensus Group (2005) Development of a common outcome data set for fall injury prevention trials: The prevention of falls network europe consensus. J Am Geriatr Soc 3: 1618–1622.
    1. Gillespie LD, Gillespie WJ, Robertson MC, Lamb SE, Cumming RG, et al. (2001) Interventions for preventing falls in elderly people. Cochrane Database Syst Rev 3: CD000340.
    1. Kasser SL, Jacobs JV, Foley JT, Cardinal BJ, Maddalozzo GF (2011) A prospective evaluation of balance, gait, and strength to predict falling in women with multiple sclerosis. Arch Phys Med Rehabil 92: 1840–1846.
    1. Gunn HJ, Newell P, Haas B, Marsden JF, Freeman JA (2013) Identification of risk factors for falls in multiple sclerosis: A systematic review and meta-analysis. Phys Ther 93: 504–513.
    1. Peterson EW, Ben Ari E, Asano M, Finlayson ML (2013) Fall attributions among middle-aged and older adults with multiple sclerosis. Arch Phys Med Rehabil 94: 890–895.
    1. Nilsagard Y, Denison E, Gunnarsson LG, Bostrom K (2009) Factors perceived as being related to accidental falls by persons with multiple sclerosis. Disabil Rehabil 31: 1301–1310.
    1. Tinetti ME, Speechley M, Ginter SF (1988) Risk factors for falls among elderly persons living in the community. N Engl J Med 319: 1701–1707.
    1. Berg WP, Alessio HM, Mills EM, Tong C (1997) Circumstances and consequences of falls in independent community-dwelling older adults. Age Ageing 26: 261–26.

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