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)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: April 23, 2018
Footnotes
Supported by the Physiotherapy Research Foundation (Chartered Society of Physiotherapy, UK, Grant PRF 10/17), the US Department of Veterans Affairs Rehabilitation Research and Development Service (CDA-2: Grant E7244-W), Multiple Sclerosis Research Australia and the National Health and Medical Research Council (NHMRC: 1117171) Australia.
Dr Cameron reports support from Adamas Pharmaceuticals, outside of the submitted work. Dr Lord declares the Physiological Profile Assessment (NeuRA FallScreen) is commercially available through Neuroscience Research Australia.
The other authors have nothing to disclose.
Identification
Copyright
© 2018 by the American Congress of Rehabilitation Medicine
