Validation of an individualized reduction of falls intervention program among wheelchair and scooter users with multiple sclerosis

Rice, Laura A.; Peterson, Elizabeth; Backus, Deborah; Sung, JongHun; Yarnot, Rebecca; Abou, Libak; Denend, Toni Van; Shen, Sa; Sosnoff, Jacob J.

doi:10.1097/md.0000000000015418

Cited by 19 publications

(15 citation statements)

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“…Demographic and clinical characteristics, frailty-related measures, and history of falls (i.e., number of falls experienced in the previous six months) were collected during a single assessment. The study consisted of a secondary analysis of baseline data collected as part of a multi-center non-randomized clinical trial focusing on a personalized fall prevention intervention (Clinicaltrials.gov Identifier: NCT03705364) [12]. Participants had to meet the following inclusion criteria: a) aged 18 years or older, b) confirmed diagnosis of MS according to the revised McDonald's diagnostic criteria 2017 [13], c) patient determined disease steps (PDDS) score of 7.0 (i.e., use of a wheelchair as primary form of mobility), d) self-reported ability to transfer independently or with minimal/moderate assistance, e) self-report of at least one fall in the previous 12 months, f) able to understand written and spoken English.…”

Section: Study Design Setting and Participantsmentioning

confidence: 99%

Frailty among people with multiple sclerosis who are wheelchair users

2022

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Background Frailty is a biological syndrome arising from cumulative declines across multiple physiologic systems. Although recent reports have described elevated frailty levels in people with multiple sclerosis (MS) with minimal to moderate disability, very little is known about frailty in individuals with severe disability. The objective of the current investigation was to evaluate frailty through the deficit accumulation model and to explore the relationship of frailty with MS clinical subtypes, disease duration and fall-history in wheelchair users living with MS. Materials and methods Standard validated procedures were used to calculate a frailty index in 45 wheelchair and scooter users living with MS (median age = 60.0[16.0] years, 82.2% female, patient determined disease steps score = 7.0). Information on demographics, MS clinical subtypes, disease duration, and six-month fall-history were collected as part of a standardized medical survey. Results The mean frailty index score was 0.54 (standard deviation = 0.13). Overall, 91.1% and 8.9% of participants met objective diagnostic criteria for severe and moderate frailty, respectively. A one-way ANOVA revealed no significant differences (F = 0.054, p = 0.948) in the frailty index among participants with relapsing-remitting MS, primary progressive, and secondary progressive MS. No relationship between frailty and disease duration (r = -0.058, p = 0.706) was found. A univariable negative binomial regression analysis revealed a significant association between frailty index scores and the number of falls experienced in the previous six months (IRR = 1.75, 95% CI [1.06–2.91], p = 0.030). Conclusion The current study suggests that individuals with MS with advanced disability also live with coexisting frailty and that the frailty index may be a valuable tool in evaluating fall-risk in wheelchair users living with MS. The significant overlap observed between severe disability and severe frailty highlights the emerging need to untangle this bi-directional relationship to identify appropriate therapeutic pathways in the MS population living with advanced disability.

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Section: Study Design Setting and Participantsmentioning

confidence: 99%

Frailty among people with multiple sclerosis who are wheelchair users

2022

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“…Falls often happen when there is a mismatch between the environment, your body, and the activity. 6 Managing the different parts of fall risk can help you avoid falls. Often that means you need to plan ahead.…”

Section: What Can You Do To Prevent Falls?mentioning

confidence: 99%

Fall Prevention for People With Multiple Sclerosis Who Use Wheelchairs and Scooters

Rice¹,

Yarnot²,

Peterson³

et al. 2021

Archives of Physical Medicine and Rehabilitation

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“…In recent years important advances in evidence-based fall prevention and management programs designed for pwMS who use wheelchairs and scooters as their primary form of mobility have been made. Specifically, a single session, 45-min intervention created by Rice et al (9) resulted in improvements in transfer quality, postural control, and reduction in fall frequency. Building upon that success, Rice et al (10) created the Individualized Reduction of FaLLs-In Person (iROLL-IP) program.…”

Section: Introductionmentioning

confidence: 99%

“…Individualized Reduction of FaLLs (iROLL) program content is evidence-based (10). Specifically, the developers of the intervention drew extensively from their research to identify and address circumstances of falls among individuals who use a wheelchair or scooter (e.g., MS symptoms, environmental hazards, activity curtailment associated with fear of falling) (2, 7,9,14). Individualized Reduction of FaLLs-In Person includes concise didactic instruction on these topics, as well as exercises to improve sitting balance and core strength, and content designed to build wheelchair/scooter and transfer skills.…”

Section: Introductionmentioning

confidence: 99%

A process evaluation of an on-line fall prevention and management program for individuals who use wheelchairs or scooters living with multiple sclerosis

Denend

Peterson

McArthur

et al. 2022

Front. Public Health

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BackgroundFalls and resulting injury are a significant concern for individuals living with multiple sclerosis (MS) that use a wheelchair and/or scooter to support mobility. Effective fall prevention efforts are vital to support the health, wellbeing, and participation for these individuals.AimsThis study reports the findings from the process evaluation conducted in association with a pilot study evaluating the efficacy of Individualized Reduction of FaLLs-Online (iROLL-O), an online, group fall prevention, and management program specifically designed for community-based people living with multiple sclerosis (pwMS) who are full-time wheelchair or scooter users.MethodsA mixed-methods process evaluation was conducted, with specific attention to the impact of online delivery on intervention implementation, participant satisfaction, and mechanisms of change (MOC). Multiple data sources were utilized, including post-session and post-intervention participant and trainer feedback forms and participant qualitative interview data. Descriptive analysis was conducted using Microsoft Excel. Close-ended questions were analyzed by examining five-point Likert scale responses. Qualitative interview data was explored using thematic analysis.ResultsTwelve participants and three trainers (one occupational therapist and two physical therapists) contributed to the study. Online delivery did not compromise session fidelity, which averaged 95%. No significant adaptations to the intervention were made during delivery. Participant satisfaction was high at 4.6/5.0. Post-course Trainer Feedback Forms indicate trainer satisfaction with the group dynamic, ability to address unique group needs, and program content. Reach improved with online delivery as transportation barriers were removed and recruitment from a broader geographic area was enabled. Three themes reflecting key MOC emerged from the analysis: group context, motivation for participant engagement, and the multifaceted nature of the program. The COVID-19 pandemic was identified as a contextual factor impacting community participation. Both participants and trainers identified the group dynamic as a strength. The trainers valued the program's flexibility in allowing them to address individual and/or group-specific fall prevention needs.ConclusionFeedback from key stakeholders was essential to a meaningful process evaluation. Online delivery supported program implementation, including reach, and resulted in high levels of satisfaction among participants and trainers. Future iterations should aim to uphold the positive group context, recruit, and train skilled interventionists who are licensed as occupational or physical therapists and continue to provide the program's diverse approach to fall prevention and management.

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Validation of an individualized reduction of falls intervention program among wheelchair and scooter users with multiple sclerosis

Abstract: Supplemental Digital Content is available in the text

Cited by 19 publications

References 50 publications

Frailty among people with multiple sclerosis who are wheelchair users

Frailty among people with multiple sclerosis who are wheelchair users

Fall Prevention for People With Multiple Sclerosis Who Use Wheelchairs and Scooters

A process evaluation of an on-line fall prevention and management program for individuals who use wheelchairs or scooters living with multiple sclerosis

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