Whom to Target for Falls-Prevention Trials

Abstract

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. 6,8,11,14 Falls in people with MS are also associated with reduced balance confidence, 15 social isolation, and reduced participation in occupational and leisure activities. 16,17 Although the cross-sectional data do not clarify the direction of these associations, it is theorized that falling likely contributes to reduced balance confidence, socialization, and participation in activities. Given the high frequency of falls in people with MS and the significant impact of these falls on people's lives, effective falls-prevention approaches are needed. MethodsThe International MS Falls Prevention Research Network (IMSFPRN) was established to help meet the need to develop and evaluate falls-prevention approaches for people with MS. The IMSFPRN held its inaugural meeting in March 2014 in Kingston, Ontario, Canada, to develop a falls-prevention intervention research protocol that could be executed at multiple sites. This meeting was attended by a multidisciplinary group of MS researchers, providers, patients, and representatives from MS support organizations and professional organizations. Different members of the group focused on and presented different specific aspects of trial design for discussion by all members of the group, and each aspect was discussed until consensus was reached. This article, which is derived from the meeting, focuses specifically on whom to include in future trials of MS falls-prevention interventions.

Three-Month Test-Retest Reliability of Center of Pressure Motion During Standing Balance in Individuals with Multiple Sclerosis

“…Overall, the inclusion criteria resulted in a sample with a high degree of imbalance and prime candidates for fall-prevention interventions and balance rehabilitation. 17 It could be expected to observe even better estimates of reliability and lesser magnitudes of differences over time for MS samples with minimal balance deficit.…”

Fall prevalence in people with multiple sclerosis who use wheelchairs and scooters

“…However, a major limitation of the research on falls and prevention strategies in PwMS is that it has almost exclusively focused on individuals who are ambulatory. Indeed, both the National MS Society's own “Free from Falls” program and the International MS falls prevention research network [ 22 , 23 ] excludes individuals who use a wheelchair or scooter as their primary means of mobility. A potential reason for this exclusion is the general lack of information concerning falls in this segment of the MS community.…”

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

“…There is emerging evidence that falls can be minimized in persons with MS with targeted interventions. [55–58] However, this research has almost exclusively focused on individuals who are ambulatory. This focus ignores the approximate 25% of the MS population [1,2] who are non-ambulatory.…”