Fear of Falling in People With Multiple Sclerosis: Which Clinical Characteristics Are Important?

Motor and Non-Motor Factors of Concern About Falling and Fear of Falling in Multiple Sclerosis

BACKGROUND AND PURPOSE

Despite the frequency of concern about falling (CAF) and fear of falling (FOF) in multiple sclerosis (MS), there remains a lack of clarity between FOF and CAF, though persons with MS have indicated that CAF and FOF are distinct constructs. Our team previously developed and validated a new questionnaire, the Concern and Fear of Falling Evaluation (CAFFE), to assess these concepts. This study aimed to examine CAF and FOF prevalence, and determine relationships among CAF, FOF, and self-reported motor, cognitive, and psychological function in MS relapsing (RRMS) and progressive (PMS) subtypes.

METHODS

In a single online survey, participants with MS completed questions about CAF and FOF, demographic information, the CAFFE, and self-report measures of motor, cognitive, and psychological function.

RESULTS

A total of 912 individuals completed the survey. Persons with PMS reported greater CAF (80.1%) and FOF (59.1%) than those with RRMS (57.0% and 41.6%, respectively). Persons with PMS endorsing FOF (yes/no) reported greater FOF on the CAFFE, greater avoidance behavior, greater walking impairment, and poorer motor function than people with RRMS ( P < 0.001). Self-reported motor function, walking impairment, and avoidance behavior were highly correlated to the CAFFE across the overall sample ( P < 0.001).

DISCUSSIONS AND CONCLUSIONS

These findings underscore the disparity between CAF and FOF, emphasize the importance of evaluating CAF and FOF in MS subtypes separately, and highlight both motor and non-motor factors contributing to CAF and FOF. Future work should focus on interventions that incorporate motor, cognitive, and psychological components to address CAF and FOF.

VIDEO ABSTRACT

for more insights from the authors Supplemental Digital Content available at http://links.lww.com/JNPT/A481 .

A machine learning approach to determine the risk factors for fall in multiple sclerosis

BACKGROUND

Falls in multiple sclerosis can result in numerous problems, including injuries and functional loss. Therefore, determining the factors contributing to falls in people with Multiple Sclerosis (PwMS) is crucial. This study aims to investigate the contributing factors to falls in multiple sclerosis using a machine learning approach.

METHODS

This cross-sectional study was conducted with 253 PwMS admitted to the outpatient clinic of a university hospital between February and August 2023. A sociodemographic data collection form, Fall Efficacy Scale (FES-I), Berg Balance Scale (BBS), Fatigue Severity Scale (FSS), Expanded Disability Status Scale (EDSS), Multiple Sclerosis Impact Scale (MSIS-29), and Timed 25 Foot Walk Test (T25-FW) were used for data collection. Gradient-boosting algorithms were employed to predict the important variables for falls in PwMS. The XGBoost algorithm emerged as the best performed model in this study.

RESULTS

Most of the participants (70.0%) were female, with a mean age of 40.44 ± 10.88 years. Among the participants, 40.7% reported a fall history in the last year. The area under the curve value of the model was 0.713. Risk factors of falls in PwMS included MSIS-29 (0.424), EDSS (0.406), marital status (0.297), education level (0.240), disease duration (0.185), age (0.130), family type (0.119), smoking (0.031), income level (0.031), and regular exercise habit (0.026).

CONCLUSIONS

In this study, smoking and regular exercise were the modifiable factors contributing to falls in PwMS. We recommend that clinicians facilitate the modification of these factors in PwMS. Age and disease duration were non-modifiable factors. These should be considered as risk increasing factors and used to identify PwMS at risk. Interventions aimed at reducing MSIS-29 and EDSS scores will help to prevent falls in PwMS. Education of individuals to increase knowledge and awareness is recommended. Financial support policies for those with low income will help to reduce the risk of falls.

Factors associated with fear of falling and fall-related injuries among people who use wheelchairs and motorized mobility scooters: a cross-sectional study

PURPOSE

To identify the factors associated with the fear of falling (FOF) and fall-related injuries (FRI) among full-time wheelchair and motorized mobility scooter (WC/S) users with various health conditions.

METHODS

This cross-sectional study included participants (≥18 years old) who used WC/S for at least one year for ≥ 75% of mobility and had a history of ≥ 1 fall in the past three years. Logistic regression models identified factors associated with FOF (yes/no) and FRI (yes/no) during the past year. Data on demographics, prior falls, mental health, environmental accessibility, and WC/S usage were used as independent variables.

RESULTS

Among 156 participants, 96% reported at least one fall within the past year, among whom 94.6% reported FOF, and 74% reported FRI within the same period. FOF was associated with fall incidence in the past year (OR = 17.75, p = 0.001). FRI was associated with higher levels of anxiety (OR = 1.15, p = 0.003) and fewer hours of WC/S use per week (OR = 0.98, p = 0.012).

CONCLUSION

This study highlights the high prevalence of FOF and FRI among WC/S users who had falls. The findings emphasized the relation between prior fall experiences and FOF and underscored the significance of addressing anxiety symptoms and WC/S usage in relation to FRI.

Discriminative ability of the original and short form of the Activities-specific Balance Confidence scale and its individual items for falls in people with multiple sclerosis

BACKGROUND

Balance confidence is an essential component of fall risk assessment in persons with multiple sclerosis (pwMS).

AIMS

The aims of this cross-sectional study were to 1) investigate the ability of the 16-item Activities-specific Balance Confidence scale (ABC-16), 6-item Activities-specific Balance Confidence scale (ABC-6), and each item of the ABC-16 for distinguishing fallers and 2) determine cutoff scores for these scales to discriminate fallers and non-fallers in pwMS.

METHODS

One hundred and fifty-six participants [fallers/non-fallers: 60 (38.5%)/96 (61.5%), median EDSS: 1.5] were enrolled. Balance confidence was assessed using the ABC-16 and ABC-6. The self-reported number of falls in the past three months was recorded. Descriptive assessments, including walking, balance, and cognition were performed. Logistic regression and receiver operating characteristic analyses were conducted to estimate the sensitivities and specificities of the ABC-16 and ABC-6.

RESULTS

Both the ABC-16 (AUC: 0.85) and ABC-6 (AUC: 0.84) had the discriminative ability for falls. Each item of the ABC-16 scale was a significantly related to falls [odds ratio (OR) range: 1.38 to 1.89]. Items 8 and 10 had the highest odds ratio (OR: 1.85; 95%CI: 1.47-2.33, OR: 1.89; 95%CI: 1.49-2.40; respectively). We found cutoff scores of ≤ 70 of 100 (sensitivity: 71.67, specificity: 86.46) and ≤ 65/100 (sensitivity: 76.67, specificity: 79.17) in discrimination between fallers and non-fallers for the ABC-16 and ABC-6, respectively.

CONCLUSION

Both original and short forms of the ABC scale are an efficient tool for discriminating fallers and non-fallers in pwMS. Although all items are related to falls, outdoor walking activities have the strongest associations with falls than other items.

Effect of melatonin intake on postural balance, functional mobility and fall risk in persons with multiple sclerosis: a pilot study

AIM

To assess the safety and the effect of a nocturnal melatonin (MEL) ingestion on postural balance, functional mobility and fall risk the following morning in adults with multiple sclerosis (MS).

METHODS

Fourteen adults with relapsing-remitting MS (RR-MS) (28.36 ± 6.81 years) were evaluated before and after nocturnal ingestion of MEL (6 mg) or placebo (PLA). Evaluations included a posturographic test of static bipedal postural balance with dual-task in eyes open (EO) and eyes closed conditions, and a clinical test of unipedal balance. The physical performance tests were: Timed Up and Go test (TUGT) (mobility), Four Square Step Test (FSST) (fall risk), and Timed 25-foot walk test (T25FWT) (walking speed). Cognitive performance [Montreal Cognitive Assessment (MoCA) and Simple Reaction Time (SRT) tests] and sleep quality [Spiegel's sleep questionnaire (SSQ)] were also assessed.

RESULTS

In EO condition, MEL decreased the posturographic parameters [center of pressure (CoP) sway area (CoPAr), CoP path length (CoPL) and CoPL in the mediolateral axis (CoPLX)] more than PLA by 15.82% (p = 0.0006), 12.48% (p  = 0.0004) and 14.25% (p = 0.0002), respectively. Durations of TUGT and FSST decreased following MEL session more than the PLA one by 14.52% (p = 0.017) and 19.85% (p = 0.0006), respectively. MEL increased the unipedal stance time, SSQ and MoCA scores more than PLA by 49.81% (p = 0.04), 32.21% (p = 0.004) and 11.87% (p = 0.008), respectively.

CONCLUSION

This pilot study showed that acute nocturnal MEL ingestion seems to be safe for enhancing postural balance, fun mobility and fall risk in RR-MS adults probably through improving sleep quality and cognitive function.

Exploring Factors Associated with Falls in Multiple Sclerosis: Insights from a Scoping Review

Multiple sclerosis (MS) is a chronic inflammatory condition that causes demyelination of the central nervous system accompanied by a wide range of symptoms. The high prevalence of falls among patients diagnosed with MS within the initial six months highlights the importance of this issue. The objective of this study is to identify factors associated with falls in MS patients in order to increase awareness and reduce the risk of falls. This scoping review used specific Mesh terms to formulate the literature search around falls and MS using Medline, Google Scholar, Scopus, and Embase search engines. English papers published between 2012 and 2022, studies with a clear definition of falls, McDonald's diagnostic criteria for MS, and those with Expanded Disability Status Scale (EDSS) or Patient Determined Disease Steps (PDDS) scores were included. Critical data from the selected articles were extracted and classified according to the different factors associated with falls in MS patients. Eighteen articles were included in this review. The most important factors associated with falls in MS patients identified were the severity and progression of the disease, mobility and balance problems, bladder dysfunction, fear of falling, fatigue, and cognitive dysfunction. In conclusion, this scoping review yielded the most common factors associated with falls in patients with MS. Study findings can be used to develop future interventions focusing on improving mobility, proprioception, and balance to decrease fall risk and injury amongst MS patients.

Fear of falling and common symptoms of multiple sclerosis: Physical function, cognition, fatigue, depression, and sleep - A systematic review

BACKGROUND

Fear of falling (FOF) is a common concern among persons with multiple sclerosis (MS) and affects the performance of their daily living activities. Falls may result in FOF, leading to worsening of symptoms of MS, physical deconditioning, and exposure to future falls. This may trigger a vicious cycle between FOF and falls. A better understanding of the relationship between FOF and symptoms of MS may be helpful to develop a conceptual model to guide fall prevention interventions.

OBJECTIVE

To synthesize the correlational and predictive relationships between FOF and common symptoms of MS.

METHODS

Databases including PubMed, Embase, Web of Science, Scopus, CINHAL, PsycINFO, and SPORTDiscuss were searched from inception to October 2023. Studies examining correlations and/or predictions between FOF and common MS symptoms that include measures of gait, postural control, fatigue, cognition, pain, sleep, depression, and anxiety were identified by two independent reviewers. Both reviewers also conducted the methodological quality assessment of the included studies.

RESULTS

Twenty-three studies with a total of 2819 participants were included in the review. Correlational findings indicated that increased FOF was significantly associated with greater walking deficits (lower gait speed, smaller steps), reduced mobility, and poorer balance. Increased FOF was also significantly correlated with higher cognitive impairments, more fatigue, sleep disturbances, and depression. Decreased gait parameters, reduced balance, lower physical functions, cognitive impairments, and sleep deficits were found as significant predictors of increased FOF.

CONCLUSION

Evidence indicates significant correlational and bidirectional predictive relationships exist between FOF and common MS symptoms. A comprehensive conceptual framework accounting for the interaction between FOF and MS symptoms is needed to develop effective falls prevention strategies.

Scale development to evaluate differences between concern about falling and fear of falling: the concern and fear of falling evaluation

Purpose

Individuals with multiple sclerosis (MS) experience fear of falling (FOF), which is associated with negative health and quality-of-life consequences. Prior research has used FOF and concern about falling (CAF) interchangeably, but persons with MS report that CAF and FOF represent separate constructs that lie on a continuum. Unfortunately, no scale exists to understand the differences between CAF and FOF. Therefore, we developed a novel questionnaire, the Concern and Fear of Falling Evaluation (CAFFE), in which respondents rank their CAF and FOF on a continuum across various activities. This study aims to describe the scale development process and examine its psychometric properties.

Methods

In a single online survey, MS participants responded to demographic questionnaires, indicated whether they experience CAF and FOF, and completed the CAFFE. Psychometric evaluation of the CAFFE involved internal consistency, split-half cross validation, exploratory factor analysis (EFA), and confirmatory factor analysis (CFA).

Results

Out of 1,025 respondents, 64.6% reported CAF and 47.2% reported FOF. The EFA yielded a two-factor solution encompassing activities in open (factor 1) and closed environments (factor 2). The CFA replicated this two-factor solution and the CAFFE demonstrated excellent internal consistency (α = 0.98).

Conclusion

The 27-item CAFFE is a highly reliable and valid measure capturing the tipping point at which point CAF moves to FOF. Future research should seek to define the tipping point from the MS community, as CAF may be an adaptive mechanism, whereas FOF may be a maladaptive behavior.

Investigation of parameters related to lower extremity muscle strength and proprioception in Patients with Multiple Sclerosis: a cross-sectional study

BACKGROUND

Patients with Multiple Sclerosis (PwMS) may experience a decline in balance, gait, and mobility as well as an increase in fear of falling (FoF) and fatigue due to weaker muscles and proprioceptive loss in their lower limbs. The study aimed to compare lower extremity muscle strength and proprioception, balance, functional mobility, gait, FoF, and fatigue between PwMS and healthy controls and to investigate the relationship between lower extremity muscle strength and proprioception and balance, functional mobility, gait, FoF, and fatigue in PwMS.

METHODS

The study was completed with 35 PwMS and 35 healthy controls with matching age and gender. The 5 Repetition Sit-to Stand Test (5-STS-test), knee and ankle reposition tests (using a digital inclinometer), the Berg Balance Scale (BBS), the Timed Up and Go (TUG) test, the Dynamic Gait Index (DGI), the Falls Efficacy-International (FES-I), and the Fatigue Severity Scale (FSS) were used for evaluations.

RESULTS

The 5-STS test, knee and ankle reposition tests, TUG, FES-I, and FSS Test scores were higher and BBS and DGI scores were lower in PwMS compared to healthy controls (p < 0.05). BBS, DGI, TUG, FES-I, and FSS were associated with 5-STS test and knee and ankle reposition tests except for some nondominant reposition tests in PwMS (r between 0.342 and -0.714; p < 0.05 for all).

CONCLUSION

Lower extremity muscle strength and proprioception were associated with balance, functional mobility, gait, FoF, and fatigue in PwMS. These results suggested that detailed assessment of neuromuscular parameters in lower extremity function is important in determining the appropriate rehabilitation programs.

Fall Assessment and Monitoring in People With Multiple Sclerosis: A Practical Evidence-Based Review for Clinicians

Purpose of Review

Falls occur in more than half of all people with multiple sclerosis (MS) but tend to be underdiagnosed and underreported in clinical encounters. This narrative review aims to summarize evidence-based approaches for evaluating fall risk and proven treatment strategies to reduce falling in people with MS to improve care for people with MS and to enhance interprofessional care coordination between treating neurologic and physical therapy (PT) teams.

Recent Findings

Screening not just for falls but for near-falls as well because fear of falling can improve fall assessment and identify patients who may benefit from fall prevention interventions. A number of barriers, including time constraints during visits and the fallacy that falling is inevitable in MS, can limit clinician awareness about patient falls and delay timely referral to PT. Consultation with physical therapists for individualized fall prevention treatment can reduce risk of falling. Interventional studies have also shown that PT-guided exercise programs improve balance confidence in people with MS. However, people with MS are often under-referred to PT by treating clinicians.

Summary

A clinical approach is provided to summarize practical, accessible, evidence-based, low-burden measurements and interventions likely to improve ascertainment of patients at risk of falling and optimize timely PT referral and treatment.

Factors contributing to falls in people with multiple sclerosis: The exploration of the moderation and mediation effects

BACKGROUND

The prevalence of multiple sclerosis (MS) has significantly increased in recent decades. People with MS have a high risk of falling; these falls may lead to serious injuries, affecting their quality of life PURPOSE: The aim of this study is to assess the factors affecting falls in people with MS and map out the most significant ones. This study also aims to determine whether fatigue has a moderation effect and balance has a mediation effect on falls in people with MS METHODS: In total, 103 people with MS with a mean age of 32.09 ± 7.17 were enrolled. All subjects were assessed for multiple variables including balance using the Berg Balance Scale (BBS), speed of gait using the Timed Up and Go (TUG) test, fear of falling using the Falls Efficacy Scale-International (FES-I), level of fatigue using the Modified Fatigue Impact Scale (MFIS), and lower limb muscle strength using a handheld digital dynamometer RESULTS: Simple binary logistic regression analysis showed significant results for BBS (OR: 10.88; 95% CI: 4.24-27.96; p < 0.0001), TUG (OR: 1.18; 95% CI: 1.09-1.28; p < 0.0001), FES-I (OR: 1.06; 95% CI: 1.02-1.10; p = 0.001), and MFIS (OR: 1.04; 95% CI: 1.02-1.07; p < 0.0001) as factors affecting falls. According to multivariate analysis, balance (OR: 3.924; 95% CI: 1.307-11.780, p = 0.015), speed of gait (OR: 1.122; 95% CI: 1.023-1.231; p = 0.015), and fatigue (OR: 1.029; 95% CI: 1.002-1.058; p = 0.038) were the strongest predicting factors of falls. Hayes's PROCESS analysis showed that fatigue had a significant moderation effect on the relationship between gait speed and falls (MFIS; β; 0.10; p < 0.0001; 95% CI: 0.07-0.14) and balance had a mediation effect on the relationship between gait speed and falls (BBS; indirect effect; 0.08; 95% CI: 0.02-0.13) CONCLUSIONS: People with MS with impaired balance, slower gait speeds, higher levels of fatigue, and a fear of falling were at a high risk of falling. The relationship between gait speed and falls can be mediated by impaired balance and moderated by the level of fatigue. Our data suggest that targeting balance and fatigue while developing rehabilitation interventions could decrease the incidence of falls among people with MS.

Circumstances and Factors Associated With Falls Among Community-Dwelling Older Adults Diagnosed With Heart Disease Using the International Mobility in Aging Study (IMIAS)

BACKGROUND AND PURPOSE

To identify the circumstances of falls and the factors associated with falls among older adults with cardiovascular disease (CVD).

METHODS

Baseline (2012) data from the International Mobility in Aging Study (IMIAS), a cross-sectional study, were used. Falling was measured by the subjective question, "Have you fallen in the last 12 months?" Several subjective questions were asked to obtain information about the circumstances of falls. Potential clinical factors associated with falling were cognitive status, depressive symptoms, physical performance, grip strength, visual acuity, and fear of falling (FOF). These clinical factors were measured respectively with the Leganes Cognitive Test, the Center for Epidemiological Studies Scales Depressive Symptoms, the Short Physical Performance Battery, a Jamar handgrip dynamometer, the Early Treatment Diabetic Retinopathy Study (ETDRS) tumbling E chart placed at 2 m, and the Falls Efficacy Scale-International. A χ 2 test was used to determine whether there were significant differences in fall circumstances among older adults with and without CVD. Two-sample t tests were used to test for any significant differences between older adults with and without CVD. Bonferroni correction was applied to limit type I errors and was corrected to .007. Simple and multiple logistic regressions identified which clinical factors were associated with falling.

RESULTS

A total of 429 older adults with CVD (mean age 69.5 ± 2.9) and 431 older adults without CVD (69.2 ± 2.9) participated in the study. Approximately 53% of fallers with CVD had 2 or more falls compared with fallers without CVD (39%). The most common location for falling was at home (43%) for fallers with CVD or in the street (50%) for fallers without CVD. Approximately 9% of fallers with CVD needed to be hospitalized while only 3% of fallers without CVD were admitted to the hospital. Approximately 42% of fallers with CVD had some residual sequelae (eg, being unable to walk around the house or do housework) compared with only 27% of fallers without CVD. Fallers with CVD had significantly ( P value < .007) more depressive symptoms (mean ± SD, 14.7 ± 12.9) and poorer physical performance (8.4 ± 3.0) compared with fallers without CVD (10.1 ± 9.4 and 9.6 ± 2.5, respectively); however FOF was the only significant clinical factor ( P value < .05) associated with falling for older adults with CVD.

CONCLUSIONS

Incidence of recurrent falls is higher among older adults with CVD than those without CVD. Circumstances of falls among fallers with CVD differ from those identified among fallers without CVD. Fear of falling was the only predictor of fall history among older adults with CVD. The results suggest the merit of considering FOF when designing prevention and intervention programs to reduce falls among older adults with CVD.

Association between Fear of Falling and Seven Performance-Based Physical Function Measures in Older Adults: A Cross-Sectional Study

Fear of falling (FOF), a common phenomenon among older adults, may result in adverse health consequences. The strength of the association between FOF and physical function among older adults has not been well compared in previous studies. Therefore, a cross-sectional study was performed on 105 older adults to determine and compare the strength of the association between FOF and seven common physical function measures. After controlling for age, logistic regression models were fitted for each physical function measure. According to odds ratios, the Berg Balance Scale (BBS), Short Physical Performance Battery, gait speed, and Timed Up & Go Test were associated with the identification of FOF. Based on a c-statistic value of 0.76, the BBS, a common and quick assessment of functional balance tasks, was found to be able to distinguish between fearful and non-fearful older adults. Interventions targeted to improve lower-extremity physical functions, especially functional balance ability, may help prevent or delay the adverse consequences of FOF.

Exercise capacity in people with Parkinson's disease: which clinical characteristics are important?

BACKGROUND

People with Parkinson's (PwP) are suffering from reduced exercise capacity. However, little information is known about clinical correlates of exercise capacity in this population.

OBJECTIVE

This study aimed to evaluate correlations between motor and non-motor symptoms with exercise capacity in PwP.

METHODS

A total of 50 individuals with Parkinson's disease participated in the study. Exercise capacity was measured by 6 minutes' walk test (6MWT). Besides, the Movement Disorder Society-Unified Parkinson's Disease Rating Scale-Part III used to evaluate disease motor severity, Berg Balance Scale to assess balance, Montréal Cognitive Assessment to evaluate cognitive status, hospital anxiety and depression scale to assess depression and anxiety, Modified Fatigue Impact scale to evaluate fatigue, and the Pittsburgh Sleep Quality Index to evaluate sleep quality.

RESULTS

The results showed that exercise capacity, when measured by the 6MWT, can be significantly predicted by balance, disease motor severity, anxiety, and age (R² = 0.61 P < .0001).

CONCLUSION

These results suggest that exercise capacity in PwP is multifactorial and can potentially be predicted by balance, motor severity, anxiety, and age.

Effect of dynamic neuromuscular stabilization on balance and trunk function in people with multiple sclerosis: protocol for a randomized control trial

Background

Multiple sclerosis is a chronic and disabling neurological disease among young people. One of the major complaints in patients with multiple sclerosis (PWMS) is falling. There are a number of factors that risk factors for falling, including balance disorder and spasticity. Core stability (CS) exercises such as trunk muscle strengthening exercises can improve balance and mobility and reduce falling. Dynamic neuromuscular stabilization (DNS) exercise is a new functional rehabilitation strategy that optimizes motor function based on the principles of developmental kinesiology. This trial will evaluate the effectiveness of DNS in comparison to CS on balance, spasticity, and falling in PWMS.

Methods

A total of 64 PWMS, between 30 and 50 years old and expanded disability status scale (EDSS) between 2 to 5, will be recruited from neurophysiotherapy clinic, Faculty of Rehabilitation Sciences, Iran University of Medical Sciences to participate in this 2-armed parallel study. Participants will be randomly divided into two groups to receive CS exercise or DNS exercise. All participants will receive exercise treatment for 15 sessions during a period of 5 weeks (3 sessions per week). Primary outcome measures will be balance. Falling rate, fear of falling, patient mobility, as well as spasticity, will be measured as secondary outcomes. All outcome measures will be measured at baseline, the day after the completion of the 15th session, and after 17 weeks.

Discussion

Dynamic neurostabilization exercises utilize the subconscious stimulation of special zones to reflexively mediate the diaphragm and other core stabilization muscles, which is extremely effective for individuals with reduced somatosensory or movement awareness. Findings from the proposed study are expected to benefit the knowledge base of the physiotherapist, and it can be a good alternative for the rehabilitation program and even reduce medication use in patients with multiple sclerosis. These exercises are easy to understand and applicable for these patients and their partners as well.

Trial registration

The trial was registered in the Iran registry organization with code IRCT20140222016680N5 and was approved on April 7^th, 2020. Address: IRCT administration team, Central Library Building, Iran University Campus, Hemmat Freeway, next to Milad tower, Tehran, Iran. postal code:14496-14535.

Prevalence of Fear of Falling and Its Association With Physical Function and Fall History Among Senior Citizens Living in Rural Areas of China

Background: Fear of falling (FOF) is as significant as a fall, leading to limited physical activity and poor quality of life among senior citizens. This study aimed to investigate the prevalence of FOF and its association with physical function and fall history among the senior citizens (≥75 years old) living in rural areas of China. Methods: This was a cross-sectional study conducted in eastern China from June to October 2019. All elderly participants were recruited during their attendance for the free health examinations in villages and towns organized by the local healthcare authorities. Data on sociodemographics, fall history, FOF conditions, self-reported comorbidity and regular medications were collected by face-to-face interview, and the physical function status was evaluated through a field test. Univariate and multivariate analyses were performed to compare the differences in physical function and fall history of senior citizens with/without FOF. Results: A total of 753 senior citizens (mean age = 79.04) participated in this study. Of these, 63.5% were aged 75-80. FOF was reported in 22.8% of the participants, while 18.5% had a fall in the past year. Among the senior citizens with and without a fall history, the prevalences of FOF were 38.8 and 19.2%, respectively. On multivariate analyses, FOF was independently associated with the Time Up and Go Test (TUG) duration (OR = 1.080; 95% CI: 1.034-1.128), 4-Stage Balance Test score (OR = 0.746; 95% CI: 0.597-0.931), fall history (OR = 2.633; 95% CI: 1.742-3.980), cerebral apoplexy (OR = 2.478; 95% CI: 1.276-4.813) and comorbidities (≥2) (OR = 1.637; 95% CI: 1.066-2.514), while the correlation between FOF and the 30-s chair stand test was only statistically significant in univariate analysis (Z = -3.528, p < 0.001). Conclusion: High prevalence of FOF is observed among the senior citizens living in rural areas of China. FOF is strongly correlated with physical function performance and fall history. Therefore, the implementation of targeted FOF prevention measures is key to improve the physical activity of the senior citizens, which would ultimately lead to fall prevention and improved quality of life.

Motivation for Physical Activity in Adults with Multiple Sclerosis: A Self-determination Theory–Based Approach

Background: Despite the benefits of regular physical activity (PA), most adults with multiple sclerosis (MS) are insufficiently active. Identifying the motivational correlates of PA is necessary to facilitate health behavior change. The extent to which the constructs of psychological need satisfaction and motivational regulations associate with self-determined PA in adults with the disease was examined.

Methods: Individuals with MS were provided a link to a web-based survey. There were 290 respondents: 242 women and 48 men aged 22 to 71 (mean ± SD, 49.50 ± 12.05) years with primarily mild-to-moderate mobility impairment who completed the Psychological Need Satisfaction in Exercise scale, the Behavioral Regulation in Exercise Questionnaire, and the International Physical Activity Questionnaire.

Results: Path analysis revealed that PA was best predicted by integrated regulation, competence, and mobility, explaining 28% of the variance in PA behavior. All three need satisfaction variables (relatedness, competence, and autonomy) and mobility impairment accounted for 43% of the variance in integrated regulation.

Conclusions: Increasing satisfaction of the need for relatedness, competence, and autonomy can lead to more integrated and internally motivated PA engagement in adults with MS.

Development of a questionnaire to assess fear of falling in children with neuromuscular diseases

Fear of falling (FOF) indicates loss of confidence in the ability to perform daily living activities without falling. Although specific questionnaires do exist to assess FOF in different patient populations, any of them targets the pediatric patients with neuromuscular diseases which falling is a frequent symptom. This study aims to present the development of a self-report FOF questionnaire for children with neuromuscular diseases, pilot application of the questionnaire, and its preliminary psychometric properties. An International Classification of Functioning, Disability and Health (ICF)-based 'Pediatric Fear of Falling Questionnaire' for neuromuscular diseases (Ped-FOF) was created by the study team following the steps of developing an instrument. The questionnaire included 34 items which were organized based on the 'Activities and Participation' component of ICF-children and youth. Thirty children with Duchenne muscular dystrophy (DMD) were recruited to obtain preliminary reliability and validity results of the questionnaire. The mean Ped-FOF score of study population was 15.30 ± 7.03. According to the preliminary results, intraclass correlation coefficient was 0.715 [confidence interval (CI) 95%], and moderate correlations between Ped-FOF and functional performance and quality of life were determined (P < 0.05). Ped-FOF promises a practical assessment of FOF in pediatrics with neuromuscular diseases with understandable items that allow self-report of children. Ped-FOF also allows clinicians and therapists to assess FOF efficiently in limited clinical time. Its preliminary reliability and validity results are also sufficient to be used in DMD that falling is a frequent condition, which indicates that the use of questionnaire is promising in many other pediatric neuromuscular disorders.

Functional gait measures correlate to fear of falling, and quality of life in patients with Hereditary Spastic Paraplegia: A cross-sectional study

OBJECTIVE

Gait impairment is the cardinal motor symptom in hereditary spastic paraplegias (HSPs) possibly linked to increased fear of falling and reduced quality of life (QoL). Disease specific symptoms in HSP are rated using the Spastic Paraplegia Rating Scale (SPRS). However, limited studies evaluated more objectively easy-to-apply gait measures by comparing these standardized assessments with patients' self-perceived impairment and clinically established scores. Therefore, the aim of this study was to correlate functional gait measures with self-rating questionnaires for fear of falling and QoL, and with the SPRS as clinical gold standard.

METHODS

HSP patients ("pure" phenotype, n = 22) fulfilling the clinical diagnostic criteria for HSP and age-and gender-matched healthy subjects (n = 22) were included in this study. Motor impairment was evaluated using the SPRS, fear of falling by the Falls Efficacy Scale-International (FES-I), and QoL by SF-12. Functional gait measures included gait speed and step length (10-meter-walk-test), the Timed up and go test (TUG), and maximum walking distance (2-min-walking-test).

RESULTS

Functional gait measures correlated to fear of falling (gait speed: r = -0.726; step length: r = -0.689; TUG: r = 0.721; 2-min: r = -0.709) and the physical component of QoL (gait speed: r = 0.541; step length: r = 0.531; TUG: r = -0.512; 2-min: r = 0.548). Furthermore, FES-I (r = 0.767) and QoL (r = -0.728) correlated with the clinical gold standard (SPRS). Gait measures strongly correlated with SPRS (gait speed: r = -0.787; step length: r = -0.821; TUG: r = 0.756; 2-min: r = -0.791).

CONCLUSION

Functional gait measures reflect fear of falling, QoL, and mobility in HSP. The metric, semi-quantitative gait measures complement the clinician's evaluation and support the clinical workup by more objective parameters.

Is there a relationship between fall status, cognition and cerebellar lobule volume in patients with multiple sclerosis?

In this prospective case control study, relationship of detailed cerebellar volumetric data and cognition in patients with multiple sclerosis considering falling status using 3 D MRI and network analysis were evaluated. Participants consist of 106 adults with relapsing-remitting multiple sclerosis. Scores of Montreal cognitive assessment test, symbol digit modality Test, nine-hole peg test, berg balance scale test, timed up and go test, timed 25-foot walk test were worse in faller group than non faller group (p < 0.05 for all tests). There was no significant difference in terms of cerebellar lobule volumes between groups. But using artificial intelligence (AI) based network analysis, we brought a new perspective to interpreting the relationship between the cerebellum, cognition, gait, and balance. Overall, data from the study suggest a possible relationship between cerebellar volume changes and cognitive dysfunction through connectivity analysis in patients with multiple sclerosis. Further studies are needed to examine this issue by using connectivity analysis.

Fear of Falling and Related Factors in Older Adults With Spinal Diseases

Fear of falling is common among older adults with spinal diseases. The purpose of the current study was to examine fear of falling and related factors in this population. A total of 138 participants were recruited and completed survey questionnaires along with the Timed Up & Go Test. Participants were 73.7 years old on average, 52% had fall experience, and 56% were taking more than four medications. Multivariate regression analyses revealed that the use of sleeping pills, residence type, pain, activities of daily living, gait ability, and gait efficacy were significant predictors of fear of falling. Findings suggest that a fall prevention intervention for older adults with spinal diseases should include pain management, functional improvement, and gait rehabilitation with a focus on gait performance and gait efficacy. In addition, it is important to improve living environment and sleep hygiene, which are conducive to falls. [Journal of Gerontological Nursing, 47(8), 29-35.].

Factors associated with fear of falling in hemodialysis patients

PURPOSE

Fear of falling (FOF) has important clinical and psychological consequences. This study evaluated the factors associated with FOF in hemodialysis patients and compared with the FOF reported by age-gender matched individuals without chronic kidney disease.

METHODS

This cross sectional study included hemodialysis group (n = 60, 55.4 ± 7.6 years, 55.0% male) and control group (n = 40, 55.1 ± 7.5 years, 52.5% male). FOF was assessed by the Falls Efficacy Scale International (FES-I). Physical function was evaluated using the Mini-Balance Evaluation Systems Test (Mini-BESTest), Timed Up and Go test, 4-m gait speed, isometric handgrip force and 10-repetition sit-to-stand test. The physical and mental components of quality of life was evaluated by 36-Item Short Form Health Survey.

RESULTS

The FES-I score was higher in the hemodialysis group compared to the control group (28.2 ± 9.7 vs. 23.3 ± 5.1, p = 0.020). In addition, the prevalence of individuals with a higher concern about falling was greater in the hemodialysis group (41.7 vs. 17.5%, p = 0.033). Multiple linear regression showed that the FES-I score was associated with the Mini-BESTest score and the physical component summary of quality of life (coefficient of determination of 0.51 and an adjusted coefficient of determination of 0.46).

CONCLUSION

FOF was associated with poor postural balance and reduced physical component of quality of life in patients on hemodialysis and these patients showed higher FOF compared to individuals without chronic kidney disease.

Understanding the influence of pain and fatigue on physical performance, fear of falling and falls in people with Parkinson's disease: a pilot study

Objective: Pain and fatigue are highly prevalent debilitating symptoms in Parkinson's disease (PD), however, their relationship with physical performance, fear of falling (FOF) and falls is not clear. We aim in this pilot study to investigate the relationship of pain and fatigue with physical performance, FOF and falls in people with Parkinson's disease (PwPD). Materials & methods: 53 PD patients were assessed for fall history, physical performance, FOF, pain and fatigue. Results: Pain and fatigue are significantly associated with physical performance and FOF (p ≤ 0.002). Pain and fatigue were different between fallers and non-fallers (p < 0.5), but only fatigue could distinguish fallers from non-fallers (area under the receiver operating characteristics curve = 0.81; p < 0.0001). Conclusion: This pilot study indicated that FOF in PwPD is significantly associated with pain and fatigue. Furthermore, fatigue level is related to fall history. By addressing pain and fatigue, we may ameliorate the deterioration of FOF and falls in PwPD.

Fear of Falling Among Community-Dwelling Older Adults with Heart Disease: Findings from an International Mobility in Aging Study (IMIAS)

Background: Older adults with heart disease (HD) are more likely to report a higher prevalence of falls compared to those without HD. A knowledge gap currently exists regarding the factors associated with fear of falling (FOF) among older adults with HD. Therefore, this study aimed to estimate FOF and identify factors associated with FOF among older adults with HD. Methods: Data came from a secondary analysis of the International Mobility in Aging Study (IMIAS) baseline (2012) data. FOF was measured using the Falls Efficacy Scale-International (FES-I). Stepwise linear regression was used to identify factors associated with FOF. Results: A total of 429 participants identified themselves as having heart disease diagnosed by their physician (mean age 69.5 ± 2.9). Older adults with HD reported on average (25.6) higher FOF than those without HD. For older adults with HD, FES-I increased significantly by 1.3, 1.0, and 0.6 points, when the Short Physical Performance Battery, the Leganes Cognitive Test, and QOL total scores decreased by one point. FES-I also significantly increased by 3.2 when income was insufficient compared to sufficient or very sufficient income. Discussion: FOF is multifactorial, and our findings provide a base for developing future management rehabilitation intervention programs aimed at decreasing FOF among older adults with HD.

Cognitive and motor slowing mediate the relationship between depression and falls in multiple sclerosis patients

OBJECTIVE

Given the limited research concerning the relationship between depression and falls in multiple sclerosis (MS), this study aimed to examine the direct and indirect association between fall history and depressive symptoms.

METHODS

One hundred and forty seven MS patients had completed at least one neuropsychological assessment that included detailed information regarding fall history, as well as measures of depression, motor function, and cognitive processing speed.

RESULTS

Fall history was associated with higher depressive symptoms and poorer overall motor function. Higher self-reported depressive symptoms were associated with higher odds of falls in the last year (OR = 1.64, 95% CI 1.16, 2.31) in an age adjusted model. Cognitive and motor slowing serially mediated the relationship between depressive symptoms and fall history (estimate = 0.060, 95% CI = 0.01, 0.15).

CONCLUSIONS

With the extensive research on the cognitive and motor correlates of falls in MS, our findings suggest that depressive symptoms are also associated with falls in people with MS. Moreover, this study provides preliminary support for a pathway by which depressive symptoms are related to falls in part through their relationships with cognitive and motor slowing.

Influence of Multiple Sclerosis on Spatiotemporal Gait Parameters: A Systematic Review and Meta-Regression

OBJECTIVE

To quantify the effect of multiple sclerosis (MS) on spatiotemporal gait characteristics accounting for disability severity and fall classification.

DATA SOURCES

MEDLINE (1946-August 2018), Allied and Complementary Medicine Database (1985-2018 August), and PsycINFO (1806-August 2018) were searched for terms on MS and gait.

STUDY SELECTION

Dual independent screening was conducted to identify observational, cross-sectional studies that compared adults with MS grouped according to Expanded Disability Status Scale (EDSS) level or fall history, reported on spatiotemporal gait characteristics, and were published in English. The search retrieved 5891 results, of which 12 studies satisfied the inclusion criteria.

DATA EXTRACTION

Two authors worked independently to extract and verify data on publication details, study methodology, participant characteristics, gait outcomes, conclusions, and limitations. Risk of bias was assessed using the QualSyst critical appraisal tool. A random-effects meta-regression and meta-analysis were conducted on pooled data.

DATA SYNTHESIS

All studies received quality ratings of very good to excellent and collectively examined 1513 individuals with MS. With every 1-point increase in EDSS, significant changes (P<.05) were observed in gait speed (-0.12 m/s; 95% confidence interval (CI), 0.08-0.15), step length (-0.04 m; 95% CI, 0.03-0.05), step time (+0.04 seconds; 95% CI, 0.02-0.06), step time variability (+0.009 seconds; 95% CI, 0.003-0.016), stride time (+0.08 seconds; 95% CI, 0.03-0.12), cadence (-4.4 steps per minute; 95% CI, 2.3-6.4), stance phase duration (+0.8% gait cycle; 95% CI, 0.1-1.5), and double support time (+3.5% gait cycle; 95% CI, 1.5-5.4). Recent fallers exhibited an 18% (95% CI, 13%-23%) reduction in gait speed compared with nonfallers (P<.001).

CONCLUSIONS

This review provides the most accurate reference values to-date that can be used to assess the effectiveness of MS gait training programs and therapeutic techniques for individuals who differ on disability severity and fall classification. Some gait adaptations could be part of adopting a more cautious gait strategy and should be factored into the design of future interventions.

Comparing the effects of vestibular rehabilitation with and without lavender oil scents as an olfactory stimulus on balance, fear of falling down and activities of daily living of people with multiple sclerosis: a randomized clinical trial

PURPOSE

To evaluate the effect of using lavender oil as an olfactory stimulus with vestibular rehabilitation (VR) on balance, fear of falling down, and activities of daily living of people with multiple sclerosis.

METHODS

Forty participants were randomly assigned into experimental and control groups. The experimental group did the VR exercises while smelling the lavender oil scents. The control group did the VR exercises without it. Both groups did the exercises in ten 45-min sessions. We assessed the participants with the timed up and go (TUG) test, Berg balance scale (BBS), fall efficacy scale - international (FES-I), and the 29-item multiple sclerosis impact scale (MSIS-29). We did the tests at the baseline and after the last exercise session.

RESULTS

The experimental group performed significantly better in the BBS (p = 0.007), TUG (p = 0.045), and FES-I (p = 0.016) tests as well as in the MSIS-29's psychological subscale (p = 0.034) than did the control group.

CONCLUSIONS

Using lavender oil as olfactory stimulus while doing the VR exercises can improve balance and reduce fear of falling down compared to doing the VR exercises without it in people with multiple sclerosis.Implications for rehabilitationIt seems that using lavender oil, as an olfactory stimulus, while doing vestibular rehabilitation exercises can improve balance and reduce fear of falling down in people with multiple sclerosis compared to doing the vestibular rehabilitation exercises without it.This treatment significantly alleviates the psychological effects of multiple sclerosis on daily life such as sleeping problems, feeling unwell, anxious, tense, depressed, etc.

State of the Art and Future Challenges in Multiple Sclerosis Research and Medical Management: An Insight into the 5th International Porto Congress of Multiple Sclerosis

The 5th International Porto Congress of Multiple Sclerosis took place between the 14th and 16th of February 2019 in Porto, Portugal. Its intensive programme covered a wide-range of themes-including many of the hot topics, challenges, pitfalls and yet unmet needs in the field of multiple sclerosis (MS)-led by a number of well-acknowledged world experts. This meeting review summarizes the talks that took place during the congress, which focussed on issues in MS as diverse as the development and challenges of progressive MS, epidemiology, differential diagnosis, medical management, molecular research and imaging tools.

Montreal cognitive assessment for evaluating cognitive impairment in multiple sclerosis: a systematic review

This study aims to systematically review the evidence on the accuracy of the Montreal Cognitive Assessment (MoCA) test for evaluating the presence of cognitive impairment in patients with multiple sclerosis (MS) and to outline the quality and quantity of research evidence available about the use of MoCA in this population. We conducted a systematic literature review, searching five databases from inception until May 2020. We identified fourteen studies that met the inclusion criteria: three cross-sectional studies and two case - control studies comparing MoCA to a battery of tests, one study comparing MoCA to Mini-Mental State Examination (MMSE), and eight studies estimating the prevalence of cognitive impairment in individuals with MS. Publication period ranged from 2012 to 2020. Although the MoCA test demonstrated good sensitivity and specificity when used at the recommended threshold of 26, a lower threshold than the original cut-off was also reported to be useful for optimal screening, as it lowers false positive rates and improves diagnostic accuracy. Furthermore, in MS patients without subjective cognitive complaints, a cutoff of 27 could provide a better balance between the sensitivity and the specificity of the test. In patients with MS, the MoCA provides information on general cognitive functions disturbances. Nonetheless, more studies are required to examine the optimum cut-off score for detecting cognitive impairments in MS patients.

Serum Tumor Necrosis Factor-Alpha Levels Correlate with Cognitive Function Scales Scores in Multiple Sclerosis Patients

BACKGROUND

Cognitive dysfunction is an important feature and source of disability for patients with multiple sclerosis (MS). The correlation of cognitive function scales' scores and serum levels of the proinflammatory cytokine tumor necrosis factor-alpha (TNF-α) in MS is not well established. We aim to investigate the correlation of TNF-α serum levels with cognitive function as measured by multiple cognitive scales in patients with MS.

METHODS

Eligible sequential MS patients attending neurology clinics between October 2018 and June 2019 at King Abdulla University Hospital (KAUH) in Jordan were included. Demographic data were collected from all participants. Motor disability was measured using the Expanded Disability Status Score (EDSS), the Functional System Score (FSS), as well as the Patient Determined Disease Steps (PDDS). The Brief International Cognitive Assessment for Multiple Sclerosis (BICAMS) and the Montreal Cognitive Assessment (MOCA) were used to evaluate the cognitive status. TNF-α serum levels were measured for each patient. Correlations of TNF-α levels with cognitive function scales' scores and motor disability scores were statistically analyzed.

RESULTS

A total of 88 MS patients were included in the study. The mean age (± SD) was 35.78 (± 10.30) years, and 72.7% were females. The majority of patients (82) had relapsing multiple sclerosis (RMS). Serum TNF-α levels were significantly correlated with scores of motor disability scales in the whole patient cohort (EDSS: Pearson correlation coefficient r = 0.230, p=0.031; FSS: r = 0.260, p=0.022; and PDDS: r = 0.261, p=0.014) and in females, but not in males. In the whole cohort, the correlation between TNF-α and EDSS score was also statistically significant (r = 0.216, p=0.047) after adjustment for confounding factors including age, disease duration, and type of MS. Likewise, Serum TNF-α levels were correlated with the scores of cognitive function scales in the whole patient cohort (BICAMS: r = -0.328, p=0.002; and MOCA: r = -0.256, p=0.016). After adjusting for age, gender, education, type of MS, and EDSS score, cognitive performance was still negatively correlated with TNF-α levels (p<0.05).

CONCLUSION

Our findings confirm the presence of a significant correlation between TNF-α levels and different cognitive scales' scores in MS patients.

Fear of falling and falls in people with multiple sclerosis: A literature review

INTRODUCTION

Fear of falling (FOF) is a widespread problem affecting about 60% of people with multiple sclerosis (pwMS). Inflammatory lesions in the brain that are caused by the disease result in gait deficits and increase the risk of fall. Falls induce fear of falling and trigger a vicious circle, which in turn increases the likelihood of falling. Objective of this review was to provide an overview of existing research on the effects of FOF and therapy options in multiple sclerosis.

METHODS

A systematic search at Web of Science and PubMed was conducted. The search included the terms (fear of falling) OR (concern about falling) OR (fall anxiety) AND (multiple sclerosis).

RESULTS

In included studies, FOF was measured by different instruments. The Falls Efficacy Scale-International (FES-I) was the most frequently used instrument for pwMS. Patients with a higher FOF score fell more frequently, had lower walking speed, shorter stride length, larger ellipse sway area and a more severe disability. At present, therapeutic offers exist mainly in the field of physiotherapy. For reducing FOF, assisted vibration (d_z = 0.68), VR (d_z =0.87) and bicycle training (d_z = 1.23) were the most effective methods.

CONCLUSION

It is advisable to develop therapies that incorporate both physical and psychological aspects in neurorehabilitation, like in a cognitive behavioral therapy. Moreover, FOF monitoring should be integrated into the clinical routine.

Nursing interventions in autologous stem cell transplantation for autoimmune diseases

AIMS

To identify clinical symptoms and nursing interventions for stem cell therapy in autoimmune diseases.

DESIGN

This is a retrospective, cross-sectional study.

METHODS

This study was undertaken with patients diagnosed with type 1 diabetes or multiple sclerosis, undergoing autologous haematopoietic stem cell transplantation from January 2004 - December 2018. Data were registered in a questionnaire, taken during the conditioning regimen comprising cyclophosphamide and rabbit anti-thymocyte globulin. Descriptive statistics and Fisher's exact test were used for data analysis.

RESULTS

There were 68 and 23 patients in the multiple sclerosis and type 1 diabetes groups respectively. Skin rash, nausea, vomiting and fever were more frequent and diverse in the type 1 diabetes group. Steroids were used as prophylaxis for anti-thymocyte globulin-associated allergic reactions in 97% of multiple sclerosis patients. Most of the identified symptoms and nursing interventions were more associated with one or other disease group (p < .05) and were more frequent in the type 1 diabetes group.

CONCLUSION

Patients with autoimmune diseases who underwent stem cell therapy present differences in their repertoire of adverse events and require disease-specific nursing actions.

IMPACT

Our results may enable nurses to establish transplant and disease-specific guidelines to improve prevention and management of adverse events and therefore optimize patient care and therapeutic success.

Effectiveness of Physical Therapy Interventions in Reducing Fear of Falling Among Individuals With Neurologic Diseases: A Systematic Review and Meta-analysis

OBJECTIVE

To summarize the effectiveness of physical therapy interventions to reduce fear of falling (FOF) among individuals living with neurologic diseases.

DATA SOURCES

PubMed, Physiotherapy Evidence Database, Scopus, Web of Science, PsycINFO, Cumulative Index to Nursing and Allied Health, and SportDiscuss were searched from inception until December 2019.

STUDY SELECTION

Clinical trials with either the primary or secondary aim to reduce FOF among adults with neurologic diseases were selected.

DATA EXTRACTION

Potential articles were screened for eligibility, and data were extracted by 2 independent researchers. Risk of bias was assessed by the Cochrane Risk of Bias tool for randomized controlled trials and the National Institutes of Health Quality Assessment Tool for pre-post studies. A meta-analysis was performed among trials presenting with similar clinical characteristics. The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) was used to rate the overall quality of evidence.

RESULTS

Sixty-one trials with 3954 participants were included in the review and 53 trials with 3524 participants in the meta-analysis. The included studies presented, in general, with a low to high risk of bias. A combination of gait and balance training was significantly more effective compared with gait training alone in reducing FOF among individuals with Parkinson disease (PD) (mean difference [MD]=11.80; 95% CI, 8.22-15.38; P<.001). Home-based exercise and leisure exercise demonstrated significant improvement in reducing FOF over usual care in multiple sclerosis (MS) (MD=15.27; 95% CI, 6.15-24.38; P=.001). No statistically significant between-groups differences were reported among individuals with stroke and spinal cord injury. The overall quality of evidence presented in this review ranges from very low to moderate according to the assessment with the GRADE approach.

CONCLUSIONS

Gait with lower limb training combined with balance training is effective in reducing FOF in individuals with PD. Also, home-based or leisure exercise is effective among individuals with MS. However, because of several limitations of the included studies, further research is needed to examine the effectiveness of FOF intervention among individuals with neurologic diseases.

Explanatory factors of balance confidence in persons with multiple sclerosis: Beyond the physical functions

BACKGROUND

Balance confidence is considered a psychological element of falls and balance-demanding activities. The relationship of balance confidence with physical factors has been investigated; however, psychosocial correlates are not well known. The aim was to investigate the relationship between balance confidence and physical and psychosocial factors and to reveal the determinants of balance confidence in persons with MS (pwMS).

METHODS

A total of 445 pwMS were enrolled in the study. Balance confidence was assessed with the Activities-Specific Balance Confidence (ABC) Scale. Psychosocial-based measures included the Modified Fatigue Impact Scale (MFIS), Epworth Sleepiness Scale (ESS), Beck Depression Scale (BDI), and Symbol Digit Modalities Test (SDMT). The Godin Leisure-Time Exercise Questionnaire (GLTEQ), Timed 25-Foot Walk (T25FW), Six-Minute Walk Test (6MWT), and Single Leg Stance Test (SLS) were used to assess physical functions.

RESULTS

There was a significant correlation between the ABC score and all physical and psychosocial measures (p<0.05). Hierarchical linear regression analyses indicated that psychosocial factors were significantly associated with ABC accounting for 41% of the variance. The addition of physical variables explained an additional 35% of variance over psychosocial variables. The MFIS, SDMT, BDI, T25FW, 6MWT, and SLS were significantly predictive of the ABC.

CONCLUSION

This study emphasizes the importance of considering both physical and psychosocial factors for understanding balance confidence in pwMS. Besides, intervention strategies for enhancing balance confidence should aim to improve fatigue, depression, and cognition in addition to physical components.

Identificação de fatores de risco para quedas em indivíduos com esclerose múltipla: uma revisão sistemática de estudos prospectivos

RESUMO O objetivo deste estudo foi identificar, a partir de uma revisão sistemática, variáveis clínicas, instrumentais e demográficas associadas com maior risco de queda em indivíduos com esclerose múltipla (EM), com base em dados prospectivos. A pesquisa foi conduzida nas bases de dados Medline, Web of Science, Bireme e CINAHL, utilizando os descritores “esclerose múltipla”, “quedas”, “quedas acidentais”, “risco de quedas”, “controle postural” e “equilíbrio”, seguido de buscas manuais. Foram considerados elegíveis estudos de coorte prospectivos, com período mínimo de acompanhamento das quedas de três meses, que avaliassem a associação de determinada variável demográfica, clínica ou instrumental em relação a maior risco de queda em indivíduos com EM. A escala de Newcastle-Ottawa modificada foi utilizada para avaliação da qualidade metodológica dos estudos incluídos. Foram identificados 357 estudos, 12 dos quais foram incluídos na revisão sistemática, com total de 1.270 pacientes incluídos. Destes, 740 (58,26%) pacientes apresentaram um ou mais episódios de queda, 396 (31,18%) apresentaram episódios de queda recorrentes (2≥quedas no período estipulado), e 530 (41,74%) não apresentaram nenhum episódio. Com exceção da espasticidade e do impacto da dupla tarefa na velocidade da marcha, todas as variáveis investigadas apresentaram resultados conflitantes quanto às suas associações a maior risco de quedas. São necessários mais estudos que apresentem homogeneidade dos fenótipos clínicos de indivíduos com EM, além da utilização de instrumentos de avaliação validados, a fim de estabelecer uma associação robusta de outras variáveis clínicas, instrumentais e demográficas com maior risco de queda.

Fear of falling in community-dwelling older adults diagnosed with cancer: A report from the International Mobility in Aging Study (IMIAS)

BACKGROUND

The incidence of fear of falling (FOF) is high among people with cancer. However, factors that are associated with FOF in people with cancer has not yet been investigated. Therefore, the objective of this study was to identify the associated factors with FOF in people with cancer.

METHOD

This is a secondary analysis of the International Mobility in Aging Study (IMIAS) study. A total of 175 people self-identified as patients with cancer (mean age: 69.3 years, women: 50.2%) and 177 healthy age-matched group. FOF measured using the Falls Efficacy Scale-International (FES-I) was the primary outcome. Potential variables/factors for consistency known to be associated with FOF (cognitive status, depression, physical performance, the number of falls in the last year, visual acuity and grip strength) were assessed. Simple linear regression was used to identify factors associated with FOF. Variables with p-value <0.05 were then included in a multiple linear regression adjusted for the study confounders (study site, sex, and age).

RESULTS

For people with cancer, FES-I was significantly associated with the Leganes Cognitive Test, The Short Physical Performance Battery (SPPB) total scores and the number of falls reported in the past 12 months (P-value <0.05). For the healthy group, FOF was only associated with depression and SPPEB.

CONCLUSION

FOF is multifactorial in people with cancer and it is associated with cognitive status, physical performance and number of falls in the last year. Healthcare providers for patients with cancer should evaluate all potential factors associated with FOF and manage it.

Psychometric properties of the Persian-version of the Activities-specific Balance Confidence scale and Fall Efficacy Scale-International in Iranian patients with multiple sclerosis

BACKGROUND AND PURPOSE

Balance impairment and fear of falling are two common risk factors for falls in people with multiple sclerosis (PwMS). Clinicians should use valid, reliable, and responsive tools to assess these risk factors and identify individuals at increased risk for falls. So, this study aimed to examine psychometric properties of the Persian-version of the Activities-specific Balance Confidence (ABC) scale and Fall Efficacy Scale-International (FES-I) in Iranian PwMS.

METHODS

One hundred and fifty-three PwMS completed the Persian versions of ABC, FES-I, Multiple Sclerosis Walking Scale-12 (MSWS-12), and Berg Balance Scale (BBS) in the first session. To assess the test-retest reliability, 50 PwMS filled out ABC, and FES-I in retest session with an interval of 2-7 days. Also, for evaluating responsiveness, 50 PwMS completed ABC and FES-I before and after a 4-week treatment.

RESULTS

Intra-class Correlation Coefficients were 0.96 and 0.93 and Cronbach's alpha coefficients were 0.96 and 0.99 for the ABC and FES-I, respectively. There were significant correlations (p < .001) between ABC and BBS (r = 0.55), FES-I and BBS (r = -0.56), ABC and MSWS-12 (r = -0.72), and FES-I and MSWS-12 (r = 0.76). No floor or ceiling effect was found. ABC and FES-I had acceptable responsiveness (AUC > 0.70), and their minimally important difference (MID) were 10.5 and 9.5 points, respectively.

CONCLUSION

The Persian-versions of ABC and FES-I are reliable, valid, and responsive measures to quantify balance confidence and fear of falling in PwMS at both clinical and research settings. The MID can help clinicians to make a decision based on the clinical significance of changes in patients' status.

A cross-sectional study on the relationship between cardiorespiratory fitness, disease severity and walking speed in persons with Multiple Sclerosis

BACKGROUND

In persons with Multiple Sclerosis (PwMS) cardiorespiratory fitness has been associated with disease severity, walking capacity and comorbidities. However, current evidence is of moderate quality and a large-scale single-center study is needed to further elucidate these relationships OBJECTIVE: The purpose of the study was 1) to examine the relationship between cardiorespiratory fitness and disease severity in PwMS; 2) to investigate the relationship between cardiorespiratory fitness and walking speed and comorbidities; and 3) to examine the potential impact of Multiple Sclerosis (MS) disease type on these relationships METHODS: Data was collected from a database consisting of data from 700 inpatients at Valens Rehabilitation Center, Switzerland. VO₂peak (cardiorespiratory fitness), information on disease course and MS type, walking performance, comorbidities and anthropometric was eligible from 242 PwMS.

RESULTS

Cardiorespiratory fitness and Expanded Disability Status Scale (EDSS) was inversely related (r = -0.465, p < .01). A multiple linear regression analysis showed that an increase of 1 point on the EDSS score was associated with a decrease of 1.88 mL kg^-1 min^-1 and explained 36% of the variance, when adjusted for time since diagnosis, gender, age, and MS type. Walking speed and cardiorespiratory fitness was significantly correlated (r = 0.584, p < .01) and the relapse remitting MS (RRMS) group (1.12 ± 0.42 m/s) walked significantly faster than the secondary progressive MS (SPMS) group (0.91 ± 0.37 m/s) p < .05, but the difference was non-significant when adjusted for age, p = .429.

CONCLUSION

The present study shows that 1) an increase of 1 EDSS point is associated with a decrease of 1.88 mL kg^-1 min^-1 when adjusted for time since diagnosis, gender, age and MS type, 2) cardiorespiratory fitness and walking speed was significantly related but only minimally affected by MS type, and 3) hypertension is associated with a lower cardiorespiratory fitness level.