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

Published:April 23, 2018DOI:https://doi.org/10.1016/j.apmr.2018.03.019

      Abstract

      Objective

      This study evaluated the relationship between physiological and perceived fall risk in people with multiple sclerosis (MS).

      Design

      Secondary analysis of data from prospective cohort studies undertaken in Australia, the United Kingdom, and the United States.

      Setting

      Community.

      Participants

      Ambulatory people with MS (N=416) (age 51.5±12.0 years; 73% female; 62% relapsing-remitting MS; 13.7±9.9 years disease duration).

      Interventions

      Not applicable.

      Main Outcome Measures

      All participants completed measures of physiological (Physiological Profile Assessment [PPA]) and perceived (Falls Efficacy Scale-international [FESi]) fall risk and prospectively recorded falls for 3 months.

      Results

      155 (37%) of the participants were recurrent fallers (≥2 falls). Mean PPA and FESi scores were high (PPA 2.14±1.87, FESi 34.27±11.18). The PPA and the FESi independently predicted faller classification in logistic regression, which indicated that the odds of being classified as a recurrent faller significantly increased with increasing scores (PPA odds ratio [OR] 1.30 [95% CI 1.17-1.46], FESi OR 1.05 [95% CI 1.03-1.07]). Classification and regression tree analysis divided the sample into four groups based on cutoff values for the PPA: (1) low physiological/low perceived risk (PPA <2.83, FESi <27.5), (2) low physiological/high perceived risk (PPA <2.83, FESi >27.5), (3) high physiological/low perceived risk (PPA >2.83, FESi <35.5), and (4) high physiological/high perceived risk (PPA <2.83, FESi >35.5). Over 50% of participants had a disparity between perceived and physiological fall risk; most were in group 2. It is possible that physiological risk factors not detected by the PPA may also be influential.

      Conclusions

      This study highlights the importance of considering both physiological and perceived fall risk in MS and the need for further research to explore the complex interrelationships of perceptual and physiological risk factors in this population. This study also supports the importance of developing behavioral and physical interventions that can be tailored to the individual’s needs.

      Keywords

      List of abbreviations:

      CART (classification and regression tree), CI (confidence interval), EDSS (Expanded Disability Status Scale), MS (multiple sclerosis), OR (odds ratio), PPA (Physiological Profile Assessment)
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