Original article| Volume 94, ISSUE 4, P616-621, April 2013

Falls in People With Multiple Sclerosis Who Use a Walking Aid: Prevalence, Factors, and Effect of Strength and Balance Interventions

Published:November 05, 2012DOI:



      To investigate falls prevalence, factors associated with falling, and the effects of balance and strengthening interventions on falls in persons with multiple sclerosis (MS).


      Baseline and posttreatment data from a randomized controlled trial.




      People with MS (N=111) who use bilateral support for gait.


      Group and one-on-one physiotherapy.

      Main Outcome Measures

      Falls prevalence was assessed using retrospective recall. Demographic information was collected, impairments of body function were assessed, and results from the Berg Balance Scale, 6-minute walk test (6MWT), Multiple Sclerosis Impact Scale-29 version 2 physical and psychological scores, and the Modified Fatigue Impact Scale (MFIS) were obtained.


      The prevalence of falls in a 3-month period was 50.5% among participants with MS, of whom 28% had more than 1 fall. Fallers had a greater physical (mean difference, −3.9; P=.048) and psychological (median difference, −4.5; P=.001) impact of MS and a greater impact of fatigue (mean difference, −9.4; P=.002). A logistic regression analysis found that the MFIS score made a unique, significant contribution to the model (odds ratio=1.04; 95% confidence interval, 1.018–1.079), correctly identifying 68% of fallers. A 10-week group physiotherapy intervention significantly reduced both the number of fallers (58.3% before to 22.9% after intervention, P=.005) and the number of falls (63 before to 25 after intervention, P=.001).


      The prevalence of falls is high in this population of persons with MS, and the impact of MS and of fatigue is greater in fallers. Development and evaluation of interventions to reduce falls risk and the transition to faller or multiple faller status are required.


      List of abbreviations:

      BBS (Berg Balance Scale), GNDS (Guys Neurological Disability Rating Scale), MFIS (Modified Fatigue Impact Scale), MS (multiple sclerosis), MSIS-29v2 (Multiple Sclerosis Impact Scale-29 version 2), 6MWT (6-minute walk test)
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        • Finlayson M.L.
        • Peterson E.W.
        • Cho C.C.
        Risk factors for falling among people aged 45 to 90 years with multiple sclerosis.
        Arch Phys Med Rehabil. 2006; 87: 1274-1279
        • Cattaneo D.
        • De Nuzzo C.
        • Fascia T.
        • Macalli M.
        • Pisoni I.
        • Cardini R.
        Risks of falls in subjects with multiple sclerosis.
        Arch Phys Med Rehabil. 2002; 83: 864-867
        • Marrie R.A.
        • Cutter G.
        • Tyry T.
        • Vollmer T.
        A cross-sectional study of bone health in multiple sclerosis.
        Neurology. 2009; 73: 1394-1398
        • Kasser S.L.
        • Jacobs J.V.
        • Foley J.T.
        • Cardinal B.J.
        • Maddalozzo G.F.
        A prospective evaluation of balance, gait, and strength to predict falling in women with multiple sclerosis.
        Arch Phys Med Rehabil. 2011; 92: 1840-1846
        • Nilsagård Y.
        • Lundholm C.
        • Denison E.
        • Gunnarsson L.G.
        Predicting accidental falls in people with multiple sclerosis—a longitudinal study.
        Clin Rehabil. 2009; 23: 259-269
        • Stevens J.A.
        • Mack K.A.
        • Paulozzi L.J.
        • Ballesteros M.F.
        Self-reported falls and fall-related injuries among persons aged ≥65 years–United States, 2006.
        J Safety Res. 2008; 39: 345-349
        • Gibson J.
        • Summers G.
        Bone health in multiple sclerosis.
        Osteoporos Int. 2011; 22: 2935-2949
        • Bazelier M.T.
        • van Staa T.
        • Uitdehaag B.M.J.
        • et al.
        The risk of fracture in patients with multiple sclerosis: the UK general practice research database.
        J Bone Miner Res. 2011; 26: 2271-2279
        • Bazelier M.T.
        • Bentzen J.
        • Vestergaard P.
        • et al.
        The risk of fracture in incident multiple sclerosis patients: The Danish National Health Registers.
        Mult Scler. 2012; 18: 1609-1616
        • Moen S.M.
        • Celius E.G.
        • Nordsletten L.
        • Holmøy T.
        Fractures and falls in patients with newly diagnosed clinically isolated syndrome and multiple sclerosis.
        Acta Neurol Scand Suppl. 2011; 124: 72-82
        • Cameron M.H.
        • Poel A.J.
        • Haselkorn J.K.
        • Linke A.
        • Bourdette D.
        Falls requiring medical attention among veterans with multiple sclerosis: a cohort study.
        J Rehabil Res Dev. 2011; 48: 13-20
        • Cattaneo D.
        • Ferrarin M.
        • Jonsdottir J.
        • Montesano A.
        • Bove M.
        The virtual time to contact in the evaluation of balance disorders and prediction of falls in people with multiple sclerosis.
        Disabil Rehabil. 2012; 34: 470-477
        • Prosperini L.
        • Kouleridou A.
        • Petsas N.
        • et al.
        The relationship between infratentorial lesions, balance deficit and accidental falls in multiple sclerosis.
        J Neurol Sci. 2011; 304: 55-60
        • Sosnoff J.J.
        • Socie M.J.
        • Boes M.K.
        • et al.
        Mobility, balance and falls in persons with multiple sclerosis.
        PLoS One. 2011; 6: 1-5
        • Matsuda P.N.
        • Shumway-Cook A.
        • Bamer A.M.
        • Johnson S.L.
        • Amtmann D.
        • Kraft G.H.
        Falls in multiple sclerosis.
        PM R. 2011; 3: 624-632
        • Matsuda P.N.
        • Shumway-Cook A.
        • Ciol M.A.
        • Bombardier C.H.
        • Kartin D.A.
        Understanding falls in multiple sclerosis: association of mobility status, concerns about falling, and accumulated impairments.
        Phys Ther. 2012; 92: 407-415
        • D'Orio V.L.
        • Foley F.W.
        • Armentano F.
        • Picone M.A.
        • Kim S.
        • Holtzer R.
        Cognitive and motor functioning in patients with multiple sclerosis: neuropsychological predictors of walking speed and falls.
        J Neurol Sci. 2012; 316: 42-46
        • Peterson E.W.
        • Cho C.C.
        • Finlayson M.L.
        Fear of falling and associated activity curtailment among middle aged and older adults with multiple sclerosis.
        Mult Scler. 2007; 13: 1168-1175
        • Cattaneo D.
        • Jonsdottir J.
        • Zocchi M.
        • Regola A.
        Effects of balance exercises on people with multiple sclerosis: a pilot study.
        Clin Rehabil. 2007; 21: 771-781
        • Smedal T.
        • Lygren H.
        • Myhr K.
        • et al.
        Balance and gait improved in patients with MS after physiotherapy based on the Bobath concept.
        Physiother Res Int. 2006; 11: 104-116
        • Lord S.
        • Wade D.
        • Halligan P.
        A comparison of two physiotherapy treatment approaches to improve walking in multiple sclerosis: a pilot randomized controlled study.
        Clin Rehabil. 1998; 12: 477
        • Esnouf J.E.
        • Taylor P.N.
        • Mann G.E.
        • Barrett C.L.
        Impact on activities of daily living using a functional electrical stimulation device to improve dropped foot in people with multiple sclerosis, measured by the Canadian Occupational Performance Measure.
        Mult Scler. 2010; 16: 1141-1147
        • Coote S.
        • Garrett M.
        • Hogan N.
        • Larkin A.
        • Saunders J.
        Getting the balance right: a randomised controlled trial of physiotherapy and exercise interventions for ambulatory people with multiple sclerosis.
        BMC Neurol. 2009; 9: 34
        • Cattaneo D.
        • Jonsdottir J.
        • Repetti S.
        Reliability of four scales on balance disorders in persons with multiple sclerosis.
        Disabil Rehabil. 2007; 29: 1920-1925
        • Cattaneo D.
        • Regola A.
        • Meotti M.
        Validity of six balance disorders scales in persons with multiple sclerosis.
        Disabil Rehabil. 2006; 28: 789-795
        • Gijbels D.
        • Alders G.
        • Van Hoof E.
        • et al.
        Predicting habitual walking performance in multiple sclerosis: relevance of capacity and self-report measures.
        Mult Scler. 2010; 16: 618-626
        • Goldman M.D.
        • Marrie R.A.
        • Cohen J.A.
        Evaluation of the six-minute walk in multiple sclerosis subjects and healthy controls.
        Mult Scler. 2008; 14: 383-390
        • Paltamaa J.
        • West H.
        • Sarasoja T.
        • Wikström J.
        • Mälkiä E.
        Reliability of physical functioning measures in ambulatory subjects with MS.
        Physiother Res Int. 2005; 10: 93-109
        • Fry D.K.
        • Pfalzer L.A.
        Reliability of four functional tests and rating of perceived exertion in persons with multiple sclerosis.
        Physiother Can. 2006; 58: 212-220
        • Hobart J.
        • Cano S.
        Improving the evaluation of therapeutic interventions in multiple sclerosis: the role of new psychometric methods.
        Health Technol Assess. 2009; 13: 1-200
        • Fisk J.D.
        • Ritvo P.G.
        • Ross L.
        • Haase D.A.
        • Marrie T.J.
        • Schlech W.F.
        Measuring the functional impact of fatigue: initial validation of the Fatigue Impact Scale.
        Clin Infect Dis. 1994; 18: S79-S83
        • Lamb S.E.
        • Jorstad-Stein E.C.
        • Hauer K.
        • Becker C.
        Development of a common outcome data set for fall injury prevention trials: the Prevention of Falls Network Europe consensus.
        J Am Geriatr Soc. 2005; 53: 1618-1622