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

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.

Quality improvement in neurology: Multiple sclerosis quality measures

“…12 Fall screening is also an opportunity for improvement: patients with MS have an increased risk of falls, do not spontaneously report falls to health care providers, and fall history has been shown to be a good predictor of future falls. [13][14][15][16] Bladder infections are common in patients with MS and proper management can reduce the risk of infection, offering an opportunity for improvement. 17 Despite the known benefits of exercise and physical activity, many persons with MS remain inactive, offering an opportunity for improvement.…”

Medications Are Associated with Falls in People with Multiple Sclerosis

“…The reasons for this difference are uncertain but may be related to younger age, which has been found to be associated with increased fall risk in MS, 26 or to other unmeasured differences in the samples or in health-care delivery between countries.…”

Whom to Target for Falls-Prevention Trials

“…[1][2][3][4][5][6][7] A number of studies also demonstrate that people with MS fall frequently 1,3,5,6,[8][9][10][11][12] and fall significantly more often than healthy people of the same age and gender. 11,13 Over 50% of people with MS fall in a 3-to 6-month period, and around 30% to 50% fall multiple times.…”

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Multiple sclerosis (MS) is a chronic neurologic disease that may cause impairments in cognition, muscle strength, muscle tone, sensation, coordination, balance, and gait, all of which are associated with an increased risk of falls.1-7 A number of studies also demonstrate that people with MS fall frequently 1,3,5,6,[8][9][10][11][12] and fall significantly more often than healthy people of the same age and gender.11,13 Over 50% of people with MS fall in a 3-to 6-month period, and around 30% to 50% fall multiple times. 3,[5][6][7]9,10 People with MS also often sustain fallrelated injuries.

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“…1-7 A number of studies also demonstrate that people with MS fall frequently 1,3,5,6,[8][9][10][11][12] and fall significantly more often than healthy people of the same age and gender.…”