The ability of clinical balance measures to identify falls risk in multiple sclerosis: a systematic review and meta-analysis

Quinn, Gillian; Comber, Laura; Galvin, Rose; Coote, Susan

doi:10.1177/0269215517748714

Cited by 35 publications

(22 citation statements)

References 63 publications

(127 reference statements)

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“…Supporting this theory, several studies have shown that patients with core activation dysfunction present lumbar pain and UI, 26,27 and they are also associated with alterations in gait patterns 28,29 . Likewise, in the specific case of patients with MS, core activation dysfunction is evidenced by a delay in the appearance of the anticipatory and compensatory postural adjustments to external disturbances, which has an effect on gait and increases risk of falls 30,31 . This last aspect is reinforced by our results, given that patients with moderate or severe dependence showed greater gait impairment than those with mild dependence or independence.…”

Section: Discussionsupporting

confidence: 82%

“…28,29 Likewise, in the specific case of patients with MS, core activation dysfunction is evidenced by a delay in the appearance of the anticipatory and compensatory postural adjustments to external disturbances, which has an effect on gait and increases risk of falls. 30,31 This last aspect is reinforced by our results, given that patients with moderate or severe dependence showed greater gait impairment than those with mild dependence or independence. This finding could be explained by greater core dysfunction being related to a more severe UI.…”

Section: Discussionsupporting

confidence: 67%

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Pelvic floor dysfunction negatively impacts general functional performance in patients with multiple sclerosis

Aguilar-Zafra¹,

Corral²,

Vidal-Quevedo

et al. 2020

Neurourology and Urodynamics

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Background There is a lack of evidence to assess whether gait functionality can be affected by the condition of the pelvic floor musculature in patients with multiple sclerosis (MS). Objective To evaluate the relationship between pelvic floor functionality and general functional performance, and also their relationship depending on dependence degree in MS patients. Participants Forty‐three MS patients performed the study. The pelvic floor musculature and its functionality were evaluated by urinary incontinence (UI), fecal incontinence, and constipation. General functional performance was evaluated by the Barthel index, the Health Status Questionnaire Short Form‐12 (SF‐12), and the Timed Up and Go (TUG) test. Results UI was moderately related to general functional performance (SF‐12 Physical: R = −0.413; Barthel index: R = −0.501; TUG: R = 0.482). The comparative analysis showed differences between UI and gait functionality (P = .008), with poorer results in the TUG in patients with moderate/severe dependence (P < .001). Conclusion UI appears to have a negative impact on the performance of daily living activities, walking, and the physical dimension of quality of life in patients with MS. In addition, patients with moderate or severe dependence showed higher UI and gait disturbance compared with those with mild dependence or independence.

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Section: Discussionsupporting

confidence: 82%

Section: Discussionsupporting

confidence: 67%

Pelvic floor dysfunction negatively impacts general functional performance in patients with multiple sclerosis

Aguilar-Zafra¹,

Corral²,

Vidal-Quevedo

et al. 2020

Neurourology and Urodynamics

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“…Interestingly, though balance is impaired in MS fallers, a recent review found that clinical balance measures in isolation are poor at identifying future fallers. 48 This suggests that other factors are also important when identifying those at risk of falling and when designing treatments for preventing falls. Other MS symptoms related to falls include fatigue, 49 cognitive impairment, 50 spasticity, 11 and urinary incontinence, 22 although, again the relationship may not be linear in nature.…”

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 identification of whether such deficits in postural control are protective or predictive of falls in pwMS is an important consideration in terms of assessment and intervention for falls in this population. A recent systematic review and meta-analysis examining the diagnostic accuracy of clinical balance measures suggests differences between fallers and non-fallers but poor predictive validity of measures overall [66]. Interestingly, Prosperini et al [48] highlight COP path length during quiet stance to have acceptable diagnostic accuracy in terms of future falls for pwMS, with longer COP path length associated with falls.…”

Section: Accepted Manuscriptmentioning

confidence: 99%

Postural control deficits in people with Multiple Sclerosis: A systematic review and meta-analysis

et al. 2018

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The ability of clinical balance measures to identify falls risk in multiple sclerosis: a systematic review and meta-analysis

Abstract: Clinical measures of balance differ significantly between fallers and non-fallers but have poor predictive ability for falls risk in people with multiple sclerosis.

Cited by 35 publications

References 63 publications

Pelvic floor dysfunction negatively impacts general functional performance in patients with multiple sclerosis

Pelvic floor dysfunction negatively impacts general functional performance in patients with multiple sclerosis

Falls in People with Multiple Sclerosis

Postural control deficits in people with Multiple Sclerosis: A systematic review and meta-analysis

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