Thursday, 9 May 2013

Are you a faller?

Falling in MSers is linked to disability. Can we prevent falls? #MSBlog #MSResearch.

EpubGunn et al. Risk factors for falls in multiple sclerosis: an observational study. Mult Scler. 2013 Apr.

BACKGROUND: MSers experience frequent falls, which are associated with impairments and limitations to activities and participations.

OBJECTIVE: The objective of this paper is to evaluate falls risk factors using robust clinical measures.

METHODS: A total of 150 individuals (confirmed MS diagnosis, Expanded Disability Status Scale (EDSS) 3.5-6.5) were recruited, with 148 participants included in the final analysis. Demographic data were collected and performance assessed in eight predictor measures (Physiological Profile Assessment (PPA), Brief Ataxia Rating scale, Ashworth scale (Ashworth), Modified Falls Efficacy scale, Symbol Digit Modalities Test, dual-task interference, lying/standing blood pressure, static/dynamic visual acuity). Participants prospectively recorded falls over three months using a daily diary. People were classified as "fallers" based on reports of ≥ two falls.

RESULTS: A total of 104 participants recorded 672 falls; 78 (52.7%) reported ≥ two falls. Continence issues, previous falls history and use of prescribed medications were each associated with increased risk of being a "faller". Ashworth and PPA risk score contributed significantly to a logistic regression model predicting faller/non-faller classification. The reduced model (Ashworth, PPA, EDSS) showed fair-to-good predictive ability (ROC c-statistic 0.73, sensitivity 70%, specificity 69%).

CONCLUSION: This study confirms the high prevalence of falls in ambulant MSers. Important potentially modifiable risk factors are identified, suggesting aspects to target in falls interventions.

"Not surprising the greatest predictor of falls is disability. Preventing disability will prevent MS-related falls and hence fractures. Easier said than done? This is why I promote early aggressive treatment; by getting on top of inflammation early in the course of MS gives you the greatest chance of preventing disability. Not all agree with me on this, but some are coming around to the idea."

"If you are a faller please speak to your physiotherapist about strategies to prevent falls. In addition, you need to get a bone density scan to see if you have thin bones. Treating thin bones will help reduce your chances of sustaining a fracture. This is also another reason to make sure you are vitamin D replete; vitamin D is good for bones."

"Ruth's talk from the MS Research day is good to watch to get up to speed on this."

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