Relationship Between Physiological and Perceived Fall Risk in People With Multiple Sclerosis: Implications for Assessment and Management

Gunn, Hilary; Cameron, Michelle; Hoang, Phu; Lord, Stephen R.; Shaw, Steve; Freeman, Jennifer

doi:10.1016/j.apmr.2018.03.019

Cited by 26 publications

(25 citation statements)

References 44 publications

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“…[83] Other studies undertaken in the US with only three subtypes, showed a higher percent for RRMS with 94.8, 5.2 for SPMS, and 0 for PPMS. [32] Based on our findings, the most common type of MS among PR patients was RR, which is similar to the most common type among the US patients. However, the second most common MS subtype in the PR population is CIS.…”

Section: Discussionsupporting

confidence: 61%

“…e initial symptoms of our MS patients were mostly a combination of the typical common symptoms such as optic, [57] 5-6.1% [58,63] 6.4% yroid 4.6% [55] 12.8% Allergies 4.9% [82] 3.2% High cholesterol 37% [58] 8.0% High blood pressure 8.0% [55] 16.7% [57] 30.1% [58,63] 18.4% Migraine 42.5% [32] 12.0% Asthma 5.3%-9%* [10] Lung disease: 13% [63] 13.6%…”

Section: Discussionmentioning

confidence: 92%

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Impact of delayed treatment on exacerbations of multiple sclerosis among Puerto Rican patients

Zarei

Maldonado

Franqui-Dominguez

et al. 2019

Surgical Neurology International

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Background: There are limited data on multiple sclerosis (MS) patients in underserved groups, including Puerto Rico. In this study, we analyzed the characteristic of MS symptoms and number of relapses in Puerto Rican patients. We then compare these characteristics with MS patients from the US. The number of MS relapses is highly correlated with the treatment onset and adherence. Patients in Puerto Rico have been experiencing lengthy treatment delay. We will discuss the possible causes of such delay and its impact on MS prognosis. Methods: This retrospective cohort study consisted of the evaluation of 325 medical records from MS patients attending the Caribbean Neurological Center from 2014 to 2019. We gathered symptoms and comorbidities data as binary objects. The treatment delay was calculated based on the mean value of days between diagnosis and treatment onset for these groups of patients. Results: We found that on average, the treatment delay for MS patients in Puerto Rico (PR) to receive their medication was 120 days. The most common MS subtype was relapsing-remitting 72.8%, with a mean of 1.684 relapses per year. Initial symptoms were sensory 54%, visual 33.1%, motor 28.8%, coordination 23.2%, fatigue 9.7%, memory 7.3%, depression 6.5%, urinary 4.9%, gastrointestinal 2.4%, and sexual dysfunction 1.6%. The most common comorbidities were hypertension 18.4%, asthma 13.6%, and thyroid disease 12.8%. When we compared the comorbidities between the two populations, immune thrombocytopenia had the highest percent change with the value of almost 200% (0.001% of US patient vs. 0.8% of Puerto Rican MS patients). Conclusion: Patients from Puerto Rico had a 33% higher relapse rate compared to the one reported for MS patients in the US. This higher rate may be related to the long delay in receiving their medications. They also had a higher rate of complex comorbidities such as immune thrombocytopenia or thyroid disease. Our findings provide a proof of concept that delay in receiving medications can increase the number of relapses and complex comorbidities among MS patients.

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Section: Discussionsupporting

confidence: 61%

Section: Discussionmentioning

confidence: 92%

Impact of delayed treatment on exacerbations of multiple sclerosis among Puerto Rican patients

Zarei

Maldonado

Franqui-Dominguez

et al. 2019

Surgical Neurology International

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“…Scale (international)), with the majority having a perceived perceptual risk greater than their physiological risk. 57 It is hypothesised that those with excessive perceptual risk may be at increased likelihood of fear of falling and associated activity curtailment, whereas those with excessive physiological risk may engage in risk-taking behaviours through an unrealistic appraisal of ability. 58 Understanding the environmental context of falls will improve management of falls in MS. Studies suggest that falls most often occur inside the home, in the morning or afternoon and during general mobility without the execution of any other specific task.…”

Section: O N L I N E F I R S Tmentioning

confidence: 99%

Falls in People with Multiple Sclerosis

Coote¹,

Comber²,

Quinn³

et al. 2020

International Journal of MS Care

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Falls are highly prevalent for people with Multiple Sclerosis (MS) and result in a range of negative consequences such as injury, activity curtailment, reduced quality of life, increased need for care and time off work. This narrative review aims to summarise key literature and to discuss future work needed in the area of falls prevention for people with MS. The incidence of falls is estimated to be over 50%; similar to the rate of falls in adults over 80 years. The consequences of falls are considerable as rate of injury is high, and fear of falling and low self-efficacy are significant problems that lead to activity curtailment. A wide range of physiological, personal and environmental factors have been highlighted as potential risk factors and predictors of falls. Falls are individual and multifactorial, and hence approaches to interventions will likely need to adopt a multi-factorial approach. However, the literature to date has largely focused on exercise-based interventions, with newer more comprehensive interventions using both education and exercise showing promising results. Several gaps remain in the topic of falls in MS and in particular the lack of standardisation of definitions and outcome measures to enable data pooling and comparison. In future, the involvement of people with MS in the design and evaluation of programmes is essential, as are approaches to intervention development that consider implementation from the outset.

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“…The PPA has been used on healthy individuals [ 31 ], subjects with neurological disorders to assess postural impairments [ 32 , 33 , 34 ] and the elderly with musculoskeletal disorders [ 35 ]. This instrument, based on interval scales [ 36 ], has been demonstrated to have psychometrically sound proprieties with a lower administrative burden compared with biomechanical assessments using motion capture and force platforms [ 30 , 33 ].…”

Section: Introductionmentioning

confidence: 99%

Physiological Profile Assessment of Posture in Children and Adolescents with Autism Spectrum Disorder and Typically Developing Peers

et al. 2020

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A sound postural system requires sensorimotor integration. Evidence suggests that individuals with Autism Spectrum Disorder (ASD) present sensorimotor integration impairments. The Physiological Profile Assessment (PPA) can be used to evaluate postural capacity assessing five physiological subsets (i.e., vision, reaction time, peripheral sensation, lower limb strength, balance); however, no studies applied the PPA in young individuals. Therefore, this study aimed to investigate the PPA in children and adolescents with ASD compared with age-matched typically developing (TD) individuals and examine the relationship between the PPA subset within the ASD and TD participants according to different age groups. Percentiles from the PPA were obtained from the TD children and adolescents (n = 135) for each test. Performances of the individuals with ASD (n = 18) were examined relative to the TD percentiles. ASD participants’ scores were above the 90th percentile (i.e., poor performance) in most sensory, motor and balance parameters. Performance in most of the PPA tests significantly improved with older age in the TD group but not in the ASD group. The study findings support the use of the PPA in TD children and adolescents while further research should investigate postural capacity in a larger ASD sample to enhance the understanding of sensorimotor systems contributing to compromised postural control.

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Relationship Between Physiological and Perceived Fall Risk in People With Multiple Sclerosis: Implications for Assessment and Management

Cited by 26 publications

References 44 publications

Impact of delayed treatment on exacerbations of multiple sclerosis among Puerto Rican patients

Impact of delayed treatment on exacerbations of multiple sclerosis among Puerto Rican patients

Falls in People with Multiple Sclerosis

Physiological Profile Assessment of Posture in Children and Adolescents with Autism Spectrum Disorder and Typically Developing Peers

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