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Moein S, Peterson EW, Kottorp A, Thompson C, Mahajan HP, Rice LA. Development, reliability, and validity assessment of a fall concerns scale for people who use wheelchairs and scooters (FCS-WC/S). Disabil Rehabil 2024:1-11. [PMID: 39140641 DOI: 10.1080/09638288.2024.2391107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Revised: 08/05/2024] [Accepted: 08/07/2024] [Indexed: 08/15/2024]
Abstract
PURPOSE To evaluate the psychometric properties of a Fall Concerns Scale for people who use Wheelchairs and Scooters (FCS-WC/S). MATERIALS AND METHODS Developed by fall prevention experts, FCS-WC/S underwent refinement through interdisciplinary reviews and focus groups with researchers, clinicians, and individuals who use WC/S full-time. The psychometric evaluation involved adults who used WC/S for ≥1 year and had ≥1 fall in the previous 3 years, recruited between April and September 2022. RESULTS The FCS-WC/S evaluates fall concerns among people with various health conditions who use WC/S full-time across 33 daily activities. One hundred and twenty-four participants responded to the baseline survey. A subgroup of 63 people repeated the FCS-WC/S a week later. The FCS-WC/S demonstrated excellent internal and good test-retest reliability (α ≥ 0.90, ICC = 0.86-0.9), as well as concurrent validity (Spearman's rho = 0.72) with the Spinal Cord Injury Falls Concern Scale (SCI-FCS). It effectively differentiated fear of falling levels from an established measure (ORs 4.1, 25.8, 46.7). Factor and parallel analysis revealed three factors, two of which were retained for further analysis. CONCLUSIONS Preliminary findings support FCS-WC/S validity and reliability for assessing fall concerns among individuals with various conditions who use WC/S. Further scale construction analysis is recommended.
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Affiliation(s)
- Sahel Moein
- Department of Kinesiology and Community Health, College of Applied Health Sciences, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Elizabeth W Peterson
- Department of Occupational Therapy, University of Illinois at Chicago, Chicago, IL, USA
| | - Anders Kottorp
- Faculty of Health and Society, Malmö University, Malmö, Sweden
| | - Charee Thompson
- Department of Communication, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Harshal P Mahajan
- Department of Kinesiology and Community Health, College of Applied Health Sciences, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Laura A Rice
- Department of Kinesiology and Community Health, College of Applied Health Sciences, University of Illinois at Urbana-Champaign, Urbana, IL, USA
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Özgür S, Koçaslan Toran M, Toygar İ, Yalçın GY, Eraksoy M. A machine learning approach to determine the risk factors for fall in multiple sclerosis. BMC Med Inform Decis Mak 2024; 24:215. [PMID: 39080657 PMCID: PMC11289943 DOI: 10.1186/s12911-024-02621-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Accepted: 07/24/2024] [Indexed: 08/02/2024] Open
Abstract
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.
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Affiliation(s)
- Su Özgür
- Department of Biostatistics and Medical Informatics, Ege University Faculty of Medicine, Izmir, Türkiye
- Ege University Faculty of Medicine, EgeSAM-Translational Pulmonary Research Center, Bornova, İzmir, Türkiye
| | - Meryem Koçaslan Toran
- Bahçeşehir University, Institution of Postgraduate Education, Istanbul, Türkiye
- Üsküdar University Faculty of Health Sciences, Istanbul, Türkiye
| | - İsmail Toygar
- Muğla Sıtkı Koçman University, Fethiye Faculty of Health Sciences , Fethiye, Muğla, Türkiye.
| | - Gizem Yağmur Yalçın
- Istanbul University-Cerrahpasa, Institute of Graduate Studies, Istanbul, Türkiye
| | - Mefkure Eraksoy
- Department of Neurology, Istanbul University Faculty of Medicine, Istanbul, Türkiye
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Morrow C, Schein R, Pramana G, McDonough C, Schmeler M. Falls in people with mobility limitations: a cross-sectional analysis of a US registry of assistive device users. Disabil Rehabil Assist Technol 2024:1-7. [PMID: 38958175 DOI: 10.1080/17483107.2024.2369654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 06/11/2024] [Accepted: 06/12/2024] [Indexed: 07/04/2024]
Abstract
Purpose of the Article: To (1) summarise the personal and clinical characteristics of persons with disabilities (PwDs) in the US who were evaluated for mobility assistive equipment (MAE) in the functional mobility assessment and uniform dataset (FMA/UDS) and (2) stratify subpopulations of PwD who reported falling versus those who do not report a fall. Materials and Methods: This study was a retrospective, descriptive cohort analysis of adults with disabilities using the FMA/UDS. Data are collected during a user's initial evaluation for a new mobility device. The sample is intentionally general to be inclusive of all mobility device users. The primary variable of interest was a patient-reported fall within the 3 months leading up to their evaluation for a new mobility device. Subpopulation characteristics were stratified by this binary fall variable. Results and Conclusions: This study provides descriptions of PwDs being evaluated for a new mobility device. There were 11,084 PwDs with 31 different primary diagnoses. During their new mobility device evaluation, 52.2% of PwDs reported at least one fall in the last 3 months. For those who reported a fall, 46.6% of PwDs were using a walking aid or no device at all before the new mobility device evaluation. Additionally, persons with progressively acquired disabilities (i.e., Parkinson's disease, osteoarthritis and cardiopulmonary disease) reported higher rates of falls than those with congenital disabilities (i.e., cerebral palsy and spina bifida). These findings will influence future studies comparing different types of devices and their influence on falls and user satisfaction.
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Affiliation(s)
- Corey Morrow
- Department of Occupational Therapy, College of Health Professions, Medical University of South Carolina, Charleston, SC, USA
| | - Richard Schein
- Department of Rehabilitation Science and Technology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Gede Pramana
- Department of Rehabilitation Science and Technology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Christine McDonough
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA, USA
| | - Mark Schmeler
- Department of Rehabilitation Science and Technology, University of Pittsburgh, Pittsburgh, PA, USA
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Moein S, Peterson EW, Rice LA. Factors associated with fear of falling and fall-related injuries among people who use wheelchairs and motorized mobility scooters: a cross-sectional study. Disabil Rehabil 2024:1-9. [PMID: 38910322 DOI: 10.1080/09638288.2024.2365984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 06/05/2024] [Indexed: 06/25/2024]
Abstract
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.
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Affiliation(s)
- Sahel Moein
- Department of Kinesiology and Community Health, College of Applied Health Sciences, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Elizabeth W Peterson
- Department of Occupational Therapy, University of Illinois at Chicago, Chicago, IL, USA
| | - Laura A Rice
- Department of Kinesiology and Community Health, College of Applied Health Sciences, University of Illinois at Urbana-Champaign, Urbana, IL, USA
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Sung J, Peters J, Bartlo W, Rice LA. A mixed-methods study examining perceptions of fear of falling among community-dwelling people who use wheelchairs full-time. Disabil Rehabil Assist Technol 2024:1-8. [PMID: 38768016 DOI: 10.1080/17483107.2024.2347312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 04/18/2024] [Indexed: 05/22/2024]
Abstract
Objective: There is growing evidence that fear of falling (FOF) is common in people who use wheelchairs full-time and negatively influence their performance of daily activities and quality of life. The purpose of this study was to gain an in-depth understanding of perceptions related to FOF among people who use wheelchairs full-time.Methods: Mixed-method analysis was conducted using semi-structured interviews and surveys to gain insight into FOF. Surveys included demographic information; Spinal Cord Injury-Fall Concerns Scale (SCI-FCS); a questionnaire that directly assesses FOF and associated activity curtailment; and Fall Control Scale (FCS).Results: Among 39 participants (age = 43.1 ± 15.6 years, disability duration = 21.2 ± 11.1 years), 27 participants (69%) reported FOF. Participants with less perceived ability to control falls indexed by FCS reported higher SCI-FCS scores, indicating greater FOF (rs = -0.384, p = 0.016). Qualitative findings revealed that participants felt that FOF developed due to sustaining fall-related injuries or limited ability to recover from a fall. Some participants perceived falling as a part of their lives. They believed that it was not the cause of developing FOF.Conclusions: Among people who use wheelchairs full-time, FOF is prevalent and may develop due to fears of sustaining injuries or being unable to get up after falling. Developing an evidenced-based education protocol aimed at managing falls (e.g., establishing a fall recovery strategy and education on techniques to reduce injury during falls) is needed to minimize FOF people who use wheelchairs full-time.
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Affiliation(s)
- JongHun Sung
- Department of Kinesiology, College of Arts and Sports, Inha University, Incheon, South Korea
| | - Joseph Peters
- Department of Health and Kinesiology, College of Applied Health Sciences, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Wendy Bartlo
- Center on Health, Aging, and Disability, College of Applied Health Sciences, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Laura A Rice
- Department of Health and Kinesiology, College of Applied Health Sciences, University of Illinois at Urbana-Champaign, Urbana, IL, USA
- Center on Health, Aging, and Disability, College of Applied Health Sciences, University of Illinois at Urbana-Champaign, Urbana, IL, USA
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Meijer U, Flink M, Tuvemo Johnson S, Kierkegaard M, Gottberg K, Ytterberg C. Preventing falls in multiple sclerosis: a qualitative study on user requirements for a self-management programme. Disabil Rehabil 2024:1-8. [PMID: 38711397 DOI: 10.1080/09638288.2024.2348725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 04/24/2024] [Indexed: 05/08/2024]
Abstract
PURPOSE To explore perspectives of ambulatory and non-ambulatory people with MS (PwMS) and health care professionals (HCPs) on falls and falls management to gain a deeper understanding of how a self-management programme can be designed to fit the needs of end users. MATERIALS AND METHODS Twelve PwMS and seven HCPs participated in three four-hour workshops based on Design Thinking. Collected data were field notes and digital post-it notes gathered at the workshops. Data were analyzed using qualitative content analysis with an inductive approach. RESULTS Two main categories, "Managing the complexity of fall-risk behaviour" and "Embracing diversity to establish group engagement", comprising a total of seven categories were constructed from the analysis. The first main category reflects the challenges PwMS face in managing fall risk in their daily lives, and the support needed to address these challenges. The second main category highlights how engaging in peer learning activities can fulfil individual needs and improve learning outcomes for PwMS. CONCLUSION A self-management fall prevention programme that is relevant to PwMS regardless of ambulation level should include the development of self-tailored behavioural strategies to prevent falls along with interactive learning activities with other PwMS.
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Affiliation(s)
- Ulrika Meijer
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
| | - Maria Flink
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
| | - Susanna Tuvemo Johnson
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
- Department of Women's and children's health, Uppsala University, Uppsala, Sweden
| | - Marie Kierkegaard
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
- Academic Specialist Center, Center of Neurology, Stockholm Health Services, Stockholm, Sweden
| | - Kristina Gottberg
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
| | - Charlotte Ytterberg
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
- Women's Health and Allied Health Professionals Theme, Karolinska University Hospital, Stockholm, Sweden
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Gopal A, Gelfand JM, Bove R, Block VJ. Fall Assessment and Monitoring in People With Multiple Sclerosis: A Practical Evidence-Based Review for Clinicians. Neurol Clin Pract 2023; 13:e200184. [PMID: 37720138 PMCID: PMC10503932 DOI: 10.1212/cpj.0000000000200184] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 07/07/2023] [Indexed: 09/19/2023]
Abstract
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.
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Affiliation(s)
- Arpita Gopal
- UCSF Weill Institute for Neurosciences (AG, JMG, RB), MS and Neuroinflammation Clinic, Department of Neurology; and Department of Physical Therapy and Rehabilitation Science (VJB), University of California, San Francisco
| | - Jeffrey M Gelfand
- UCSF Weill Institute for Neurosciences (AG, JMG, RB), MS and Neuroinflammation Clinic, Department of Neurology; and Department of Physical Therapy and Rehabilitation Science (VJB), University of California, San Francisco
| | - Riley Bove
- UCSF Weill Institute for Neurosciences (AG, JMG, RB), MS and Neuroinflammation Clinic, Department of Neurology; and Department of Physical Therapy and Rehabilitation Science (VJB), University of California, San Francisco
| | - Valerie J Block
- UCSF Weill Institute for Neurosciences (AG, JMG, RB), MS and Neuroinflammation Clinic, Department of Neurology; and Department of Physical Therapy and Rehabilitation Science (VJB), University of California, San Francisco
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Zanotto T, Sosnoff JJ, Backus D, Yarnot R, Worikat NA, Abou L, Peterson EW, Rice LA. Characteristics and consequences of falls among people with multiple sclerosis who use wheelchairs or scooters: Differences between injurious and non-injurious falls. Mult Scler Relat Disord 2023; 73:104631. [PMID: 36963170 DOI: 10.1016/j.msard.2023.104631] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 03/03/2023] [Accepted: 03/19/2023] [Indexed: 03/26/2023]
Abstract
BACKGROUND Falls are common among people living with multiple sclerosis (MS) who use wheelchairs or scooters. Falls may lead to severe consequences including physical injuries. However, very little is known about the circumstances associated with injurious falls in this population. Therefore, we aimed to explore the differences in fall-related characteristics between injurious and non-injurious falls among people with MS who use wheelchairs or scooters. METHODS A convenience sample of 48 people with MS (age = 62.0 [13.0] years, gender = 81.3% female, primary mobility aid = power wheelchair) completed a fall-history survey that examined the characteristics and consequences of their most recent fall. Participants also completed standard questionnaires on quality of life, community participation, and fear of falling. RESULTS Most falls (85.4%) reported by participants occurred inside the house. Twelve (25.0%) participants reported experiencing fall-related injuries such as bruises, cuts, muscle strains, and fractures. People who reported being injured after a fall had a higher proportion of falls that occurred during transfers compared to those who were not injured (n = 10, 83.3% vs n = 17, 47.2%). Most participants (45.8%) did not receive any information from healthcare professionals on how to manage their fall-risk after their fall experience. No differences between injurious and non-injurious fallers in quality of life, community participation, and fear of falling were observed. CONCLUSIONS This cross-sectional investigation provides compelling evidence that people with MS who use wheelchairs or scooters are at high risk of fall-related injuries. The study findings underscore the importance of increasing health care providers' awareness about the frequency and consequences of falls. Further, it demonstrates the critical need for evidence-based interventions specifically designed to minimize fall-related injuries in this vulnerable population.
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Affiliation(s)
- Tobia Zanotto
- Department of Occupational Therapy Education, School of Health Professions, University of Kansas Medical Center, Kansas City, KS, USA; Mobility Core, University of Kansas Center for Community Access, Rehabilitation Research, Education and Service, Kansas City, KS, USA.
| | - Jacob J Sosnoff
- Mobility Core, University of Kansas Center for Community Access, Rehabilitation Research, Education and Service, Kansas City, KS, USA; Department of Physical Therapy, Rehabilitation Science, and Athletic Training, School of Health Professions, University of Kansas Medical Center, Kansas City, KS, USA; MS Research Collaborative, College of Applied Health Sciences, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Deborah Backus
- Crawford Research Institute, Shepherd Center, Atlanta, GA, USA
| | - Rebecca Yarnot
- Department of Kinesiology and Community Health, College of Applied Health Sciences, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Nida' Al Worikat
- Department of Occupational Therapy Education, School of Health Professions, University of Kansas Medical Center, Kansas City, KS, USA
| | - Libak Abou
- Department of Physical Medicine and Rehabilitation, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Elizabeth W Peterson
- Department of Occupational Therapy, University of Illinois at Chicago, Chicago, IL, USA
| | - Laura A Rice
- MS Research Collaborative, College of Applied Health Sciences, University of Illinois at Urbana-Champaign, Urbana, IL, USA; Department of Kinesiology and Community Health, College of Applied Health Sciences, University of Illinois at Urbana-Champaign, Urbana, IL, USA; Center on Health, Aging and Disability, College of Applied Health Sciences, University of Illinois at Urbana-Champaign, Urbana, IL, USA
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McArthur AR, Peterson EW, Sosnoff J, Backus D, Yarnot R, Abou L, Kish J, Steinkellner S, Sandhu A, Rice L. Online Delivery of the Individualized Reduction of Falls Intervention for Persons With Multiple Sclerosis Who Use a Wheelchair or Scooter Full-time: A Pilot Study. Int J MS Care 2023; 25:82-90. [PMID: 36923574 PMCID: PMC10010107 DOI: 10.7224/1537-2073.2022-044] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2023]
Abstract
BACKGROUND People with multiple sclerosis (MS) who use a wheelchair or scooter full-time fall frequently; however, fall prevention programming that meets the unique needs of this population is limited. This study examined the preliminary efficacy of a group-based online fall prevention and management intervention designed specifically for people with MS. METHODS This pre/post intervention, mixed-methods study included people with MS who used a wheelchair or scooter full-time, experienced at least 1 fall within the past year, and transferred independently or with minimal or moderate assistance. Participants engaged in a 6-week, online, individualized, multicomponent fall prevention and management intervention: Individualized Reduction of Falls-Online (iROLL-O). RESULTS No statistically significant change in fall incidence occurred after iROLL-O. However, fear of falling significantly decreased (P < .01) and knowledge related to fall management (P = .04) and fall prevention and management (P = .03) significantly improved. Qualitative results indicated that participants valued the opportunity for peer learning and iROLL-O's attention to diverse influences on fall risk. CONCLUSIONS This study is the first to examine the preliminary efficacy of an online fall prevention and management intervention for people with MS who use a wheelchair or scooter full-time. iROLL-O has promise, and participants found it valuable. Further efforts are needed to retain iROLL-O participants with lower confidence and functional mobility, and more research is needed to investigate the impact of the intervention on key outcomes over time.
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Affiliation(s)
- Amy Roder McArthur
- Department of Disability and Human Development (ARMA, JK), University of Illinois Chicago, Chicago, IL, USA
- Department of Occupational Therapy (ARMA, EWP), College of Applied Health Sciences, University of Illinois Chicago, Chicago, IL, USA
| | - Elizabeth Walker Peterson
- Department of Occupational Therapy (ARMA, EWP), College of Applied Health Sciences, University of Illinois Chicago, Chicago, IL, USA
| | - Jacob Sosnoff
- Department of Physical Therapy, Rehabilitation Science, and Athletic Training, University of Kansas Medical Center, Kansas City, KS, USA (JS)
| | - Deborah Backus
- Virginia Crawford Research Institute, Shepherd Center, Atlanta, GA, USA (DB)
| | - Rebecca Yarnot
- Department of Kinesiology and Community Health (RY, SS, AS, LR), College of Applied Health Sciences, University of Illinois at Urbana-Champaign, Champaign, IL, USA
| | - Libak Abou
- Department of Physical Medicine and Rehabilitation, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA (LA)
| | - Jacqueline Kish
- Department of Disability and Human Development (ARMA, JK), University of Illinois Chicago, Chicago, IL, USA
| | - Sydney Steinkellner
- Department of Kinesiology and Community Health (RY, SS, AS, LR), College of Applied Health Sciences, University of Illinois at Urbana-Champaign, Champaign, IL, USA
| | - Arman Sandhu
- Department of Kinesiology and Community Health (RY, SS, AS, LR), College of Applied Health Sciences, University of Illinois at Urbana-Champaign, Champaign, IL, USA
| | - Laura Rice
- Department of Kinesiology and Community Health (RY, SS, AS, LR), College of Applied Health Sciences, University of Illinois at Urbana-Champaign, Champaign, IL, USA
- Center on Health, Aging, and Disability (LR), College of Applied Health Sciences, University of Illinois at Urbana-Champaign, Champaign, IL, USA
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Tuvemo Johnson S, Flink M, Peterson E, Gottberg K, Elf M, Johansson S, Kierkegaard M, Ytterberg C. Self-management of falls in people with multiple sclerosis: A scoping review. Clin Rehabil 2023; 37:162-176. [PMID: 36177511 PMCID: PMC9772893 DOI: 10.1177/02692155221128723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 09/02/2022] [Indexed: 12/25/2022]
Abstract
OBJECTIVE Falls are common in people with multiple sclerosis. There is rising interest in how the multifactorial and chronic nature of fall risk among people with multiple sclerosis can be addressed through self-management. Thus, the aims were to investigate the extent and the scope of publications on self-management of falls in people with multiple sclerosis, and to identify how the concept of self-management was defined and used. DATA SOURCES A systematic literature search in Medline, Cochrane, Web of Science and PsycInfo was conducted to identify publications until July 2022. REVIEW METHODS Published methodological guidance was followed. Articles targeting: (1) people with multiple sclerosis, (2) falls, and (3) self-management were selected. Of 1656 records, 203 publications were assessed for eligibility, of which 173 did not meet the inclusion criteria, and 16 publications did not contain empirical data. The type of publication, study focus, and study design was extracted. If applicable, key findings, self-management tasks and skills, and the definition of self-management were extracted. RESULTS Fourteen original articles met all inclusion criteria. Ten articles represented six different fall prevention interventions. Three publications were randomized controlled trials. Self-management content was variable and not comprehensive in nature. None of the 14 publications included a self-management definition. CONCLUSION The limited number of original articles and the even fewer intervention studies show that the research on self-management of falls in people with multiple sclerosis is in its infancy. To progress in the research area of self-management of falls, a more robust, consensus-based description of self-management frameworks and activities is needed.
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Affiliation(s)
- Susanna Tuvemo Johnson
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
| | - Maria Flink
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
- Women’s Health and Allied Health Professionals Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Elizabeth Peterson
- Department of Occupational Therapy, University of Illinois, Chicago, IL, USA
| | - Kristina Gottberg
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
| | - Marie Elf
- School of Education and Learning, Dalarna University, Falun, Sweden
| | - Sverker Johansson
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
- Women’s Health and Allied Health Professionals Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Marie Kierkegaard
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
- Academic Specialist Center, Center of Neurology, Stockholm Health Services, Stockholm, Sweden
| | - Charlotte Ytterberg
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
- Women’s Health and Allied Health Professionals Theme, Karolinska University Hospital, Stockholm, Sweden
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Van Denend T, Peterson EW, McArthur AR, Yarnot R, Kish J, Steinkellner S, Sandhu A, Rice LA. A process evaluation of an on-line fall prevention and management program for individuals who use wheelchairs or scooters living with multiple sclerosis. Front Public Health 2022; 10:1042668. [PMID: 36579061 PMCID: PMC9791181 DOI: 10.3389/fpubh.2022.1042668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 11/23/2022] [Indexed: 12/14/2022] Open
Abstract
Background Falls and resulting injury are a significant concern for individuals living with multiple sclerosis (MS) that use a wheelchair and/or scooter to support mobility. Effective fall prevention efforts are vital to support the health, wellbeing, and participation for these individuals. Aims This study reports the findings from the process evaluation conducted in association with a pilot study evaluating the efficacy of Individualized Reduction of FaLLs-Online (iROLL-O), an online, group fall prevention, and management program specifically designed for community-based people living with multiple sclerosis (pwMS) who are full-time wheelchair or scooter users. Methods A mixed-methods process evaluation was conducted, with specific attention to the impact of online delivery on intervention implementation, participant satisfaction, and mechanisms of change (MOC). Multiple data sources were utilized, including post-session and post-intervention participant and trainer feedback forms and participant qualitative interview data. Descriptive analysis was conducted using Microsoft Excel. Close-ended questions were analyzed by examining five-point Likert scale responses. Qualitative interview data was explored using thematic analysis. Results Twelve participants and three trainers (one occupational therapist and two physical therapists) contributed to the study. Online delivery did not compromise session fidelity, which averaged 95%. No significant adaptations to the intervention were made during delivery. Participant satisfaction was high at 4.6/5.0. Post-course Trainer Feedback Forms indicate trainer satisfaction with the group dynamic, ability to address unique group needs, and program content. Reach improved with online delivery as transportation barriers were removed and recruitment from a broader geographic area was enabled. Three themes reflecting key MOC emerged from the analysis: group context, motivation for participant engagement, and the multifaceted nature of the program. The COVID-19 pandemic was identified as a contextual factor impacting community participation. Both participants and trainers identified the group dynamic as a strength. The trainers valued the program's flexibility in allowing them to address individual and/or group-specific fall prevention needs. Conclusion Feedback from key stakeholders was essential to a meaningful process evaluation. Online delivery supported program implementation, including reach, and resulted in high levels of satisfaction among participants and trainers. Future iterations should aim to uphold the positive group context, recruit, and train skilled interventionists who are licensed as occupational or physical therapists and continue to provide the program's diverse approach to fall prevention and management.
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Affiliation(s)
- Toni Van Denend
- Department of Occupational Therapy, University of Illinois Chicago, Chicago, IL, United States
| | - Elizabeth W. Peterson
- Department of Occupational Therapy, University of Illinois Chicago, Chicago, IL, United States
| | - Amy Roder McArthur
- Department of Occupational Therapy, University of Illinois Chicago, Chicago, IL, United States
- Department of Disability and Human Development, College of Applied Health Sciences, University of Illinois Chicago, Chicago, IL, United States
| | - Rebecca Yarnot
- Department of Kinesiology and Community Health, University of Illinois Urbana-Champaign, Urbana, IL, United States
| | - Jacqueline Kish
- Department of Occupational Therapy, University of Illinois Chicago, Chicago, IL, United States
- Department of Disability and Human Development, College of Applied Health Sciences, University of Illinois Chicago, Chicago, IL, United States
| | - Sydney Steinkellner
- Department of Kinesiology and Community Health, University of Illinois Urbana-Champaign, Urbana, IL, United States
| | - Arman Sandhu
- Department of Kinesiology and Community Health, University of Illinois Urbana-Champaign, Urbana, IL, United States
| | - Laura A. Rice
- Department of Kinesiology and Community Health, University of Illinois Urbana-Champaign, Urbana, IL, United States
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Shariat A, Ghayour Najafabadi M, Soroush Fard Z, Nakhostin-Ansari A, Shaw BS. A systematic review with meta-analysis on balance, fatigue, and motor function following aquatic therapy in patients with multiple sclerosis. Mult Scler Relat Disord 2022; 68:104107. [PMID: 35988329 DOI: 10.1016/j.msard.2022.104107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 08/05/2022] [Accepted: 08/12/2022] [Indexed: 12/15/2022]
Abstract
OBJECTIVE In this systematic review and meta-analysis, we aimed to evaluate the impact of long-term aquatic exercise training on balance, fatigue, and motor function. METHODS Scopus, PubMed, Web of Science, Cochrane Central Register of Controlled Trials, Ovid Medline, EBSCO Cumulative Index to Nursing, and Allied Health Literature were searched on April 19, 2021. The search included randomized and non-randomized controlled trials, case-control studies, case series, and case reports. Two independent reviewers reviewed titles and abstracts to determine which studies satisfied the eligibility criteria. Two reviewers independently surveyed the full texts and conducted the study selection, data extraction, and quality assessment. Data synthesis was applied to summarize information from included studies. Meta-analysis was performed using RevMan 5. RESULTS From 170 studies that were identified in the initial search, 16 trials (794 participants) satisfied the eligibility criteria. Aquatic therapy had a positive effect on fatigue compared to control group based on Modified Fatigue Impact Scale (MFIS) in physical (SMD, -1.29; 95% CI, [(-1.65) - (-0.93)]; I2=88%) cognitive (SMD, -0.75; 95% CI, [(-1.08)-(- 0.43)]; I2=78%), and psychological (SMD, -1.25; 95% CI, [(-1.59) - (-0.90)]; I2=79%) domains, and Fatigue Severity Scale (FSS) (SMD, -0.53; 95% CI, [(-0.86) - (-0.20)]; I2=57%). In addition, aquatic therapy improved balance based on the Berg Balance Scale (BBS) compared to the control group (SMD, 1.19; 95% CI, [(0.62)-(1.76)]; I2=11%) CONCLUSIONS: Aquatic therapy has positive effects on fatigue and balance. Further research is needed to confirm the clinical utility of aquatic therapy for multiple sclerosis patients in the long term.
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Affiliation(s)
- Ardalan Shariat
- Department of Digital Health, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahboubeh Ghayour Najafabadi
- Department of motor behavior, Faculty of physical education and sport science, University of Tehran, Tehran, Iran.
| | - Zahra Soroush Fard
- Department of Sports Injury, Faculty of physical education and sport science, University of Tehran, Tehran, Iran
| | - Amin Nakhostin-Ansari
- Sports Medicine Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran; Neuromusculoskeletal Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Brandon S Shaw
- School of Sport, Rehabilitation and Exercise Sciences, University of Essex, Wivenhoe Park, Colchester, Essex, United Kingdom
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13
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Matsuda PN, Hoffman JM. Patient perspectives on falls in persons with multiple sclerosis. PM R 2022; 14:1474-1482. [PMID: 34676992 DOI: 10.1002/pmrj.12724] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 08/27/2021] [Accepted: 10/10/2021] [Indexed: 01/01/2023]
Abstract
INTRODUCTION Falls and their consequences are known to be major contributors to decreased health and well-being in older adults. Several studies suggest that fall rates are higher among individuals with disabling conditions such as multiple sclerosis (MS). However, there is a knowledge gap regarding how individuals with a disability define falls or understand their consequences. OBJECTIVE To gain the perspective of community-dwelling adults living with MS about falls and their consequences and to understand the conditions and circumstances surrounding falls, and to identify the specific attributes of a community fall-prevention program that would facilitate participation. DESIGN Focus groups or individual interviews were conducted with people with MS. SETTING/PARTICIPANTS Community-dwelling adults living with MS (n = 20) (men = 8 [34.7%], mean age 63.2 years [standard deviation (SD) 5.3, range 55-75]). Average time since diagnosis was 20.6 years (SD 9.6, range 9-44). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Not applicable. RESULTS All participants agreed that the definition of a fall required "ending up on the floor." However, the starting point differed depending on mobility ability and device use. When using the most common research definition, individuals reported an increase in their number of falls as compared to when using their personal definition. Most participants considered "fear of falling" to be different from "concern about falling." Participants wanted to learn how to fall and would not join a program with the word "fall" in the title. CONCLUSIONS Results suggest that fall data for individuals with MS may not be reported accurately. Health care providers would get more accurate data if they provide specific definitions for falls and ask specifically about fear and concern about falling. Patient-centered programming needs to be developed that includes both how to fall and how to engage people with MS, including potential facilitators and barriers to participation.
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Affiliation(s)
- Patricia Noritake Matsuda
- Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | - Jeanne M Hoffman
- Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, WA, USA
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Van Denend T, Peterson EW, Sung J, Rice LA. Process evaluation findings of a fall prevention and management program for wheelchair and scooter users with multiple sclerosis. PEC INNOVATION 2022; 1:100081. [PMID: 37213774 PMCID: PMC10194268 DOI: 10.1016/j.pecinn.2022.100081] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 08/16/2022] [Accepted: 09/01/2022] [Indexed: 05/23/2023]
Abstract
Objective To describe process evaluation findings of a clinical trial to evaluate the Individualized Reduction of Falls (iROLL) program, a 6-session, group-based intervention designed to reduce fall incidence among people living with multiple sclerosis (MS) who use a wheelchair or scooter full-time. Methods A mixed-methods process evaluation focusing on implementation and mechanisms of impact (MOI) was conducted. Both iROLL participants and trainers (licensed occupational or physical therapists) provided input. Results Seventeen iROLL participants and nine trainers participated. The overall session attendance rate was 93%. Content and logistics fidelity were 95% and 90%, respectively and average overall participant satisfaction rating was 4.7/5.0. Five MOI themes emerged: group dynamic, comprehensive nature of the program, strong program development, role of a skilled interventionist, and motivated participants. Recruitment challenged program reach. Conclusion iROLL is acceptable to the target audience, can be delivered with high fidelity and has diverse and interacting mechanisms of impact operating. Remote delivery may improve reach. Innovation Effective iROLL delivery requires trainers with strong group management skills who can also individualize material while maintaining program fidelity. Comprehensive training and on-going support of the occupational and physical therapists delivering iROLL bolsters program effectiveness. Program access may improve with online delivery.
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Affiliation(s)
- Toni Van Denend
- Department of Occupational Therapy, University of Illinois Chicago, IL, USA
| | | | - JongHun Sung
- Department of Kinesiology, College of Arts & Sports, Inha University, Incheon, South Korea
| | - Laura A. Rice
- Department of Kinesiology and Community Health, University of Illinois Urbana-Champaign, Urbana, IL, USA
- Corresponding author at: 219 Freer Hall, 906 S. Goodwin Ave. Urbana, IL 61801, USA.
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Frechette M, Fanning J, Hsieh K, Rice L, Sosnoff J. The Usability of a Smartphone-Based Fall Risk Assessment App for Adult Wheelchair Users: Observational Study. JMIR Form Res 2022; 6:e32453. [PMID: 36112405 PMCID: PMC9526126 DOI: 10.2196/32453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 04/22/2022] [Accepted: 06/27/2022] [Indexed: 12/04/2022] Open
Abstract
Background Individuals who use wheelchairs and scooters rarely undergo fall risk screening. Mobile health technology is a possible avenue to provide fall risk assessment. The promise of this approach is dependent upon its usability. Objective We aimed to determine the usability of a fall risk mobile health app and identify key technology development insights for aging adults who use wheeled devices. Methods Two rounds (with 5 participants in each round) of usability testing utilizing an iterative design-evaluation process were performed. Participants completed use of the custom-designed fall risk app, Steady-Wheels. To quantify fall risk, the app led participants through 12 demographic questions and 3 progressively more challenging seated balance tasks. Once completed, participants shared insights on the app’s usability through semistructured interviews and completion of the Systematic Usability Scale. Testing sessions were recorded and transcribed. Codes were identified within the transcriptions to create themes. Average Systematic Usability Scale scores were calculated for each round. Results The first round of testing yielded 2 main themes: ease of use and flexibility of design. Systematic Usability Scale scores ranged from 72.5 to 97.5 with a mean score of 84.5 (SD 11.4). After modifications were made, the second round of testing yielded 2 new themes: app layout and clarity of instruction. Systematic Usability Scale scores improved in the second iteration and ranged from 87.5 to 97.5 with a mean score of 91.9 (SD 4.3). Conclusions The mobile health app, Steady-Wheels, has excellent usability and the potential to provide adult wheeled device users with an easy-to-use, remote fall risk assessment tool. Characteristics that promoted usability were guided navigation, large text and radio buttons, clear and brief instructions accompanied by representative illustrations, and simple error recovery. Intuitive fall risk reporting was achieved through the presentation of a single number located on a color-coordinated continuum that delineated low, medium, and high risk.
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Affiliation(s)
- Mikaela Frechette
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, IL, United States
- Siebel Center for Design, University of Illinois at Urbana-Champaign, Champaign, IL, United States
| | - Jason Fanning
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, NC, United States
| | - Katherine Hsieh
- Department of Internal Medicine, Section on Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Winston-Salem, NC, United States
| | - Laura Rice
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, IL, United States
- Illinois Multiple Sclerosis Research Collaborative, University of Illinois at Urbana-Champaign, Urbana, IL, United States
- Center on Health, Aging, and Disability, University of Illinois at Urbana-Champaign, Urbana, IL, United States
| | - Jacob Sosnoff
- Illinois Multiple Sclerosis Research Collaborative, University of Illinois at Urbana-Champaign, Urbana, IL, United States
- Department of Physical Therapy, Rehabilitation Science, and Athletic Training, University of Kansas Medical Center, Kansas City, KS, United States
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Rice LA, Yarnot R, Sung J, Sosnoff JJ, Backus D, Abou L, Shen S, Peterson EW. Pilot Study of a Fall Prevention and Management Intervention Program for People With Multiple Sclerosis Who Use a Wheelchair or Scooter Full-Time. Arch Rehabil Res Clin Transl 2022; 4:100225. [PMID: 36545518 PMCID: PMC9761259 DOI: 10.1016/j.arrct.2022.100225] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Objective To examine the efficacy of a fall prevention/management intervention among persons with multiple sclerosis (PwMS) who use a wheelchair (WC) or scooter full-time. Design Pre-post/follow-up trial. Setting Community and research laboratory. Participants Twenty-one PwMS who used a WC or scooter full-time, self-reported at least 1 fall/12 months, and could transfer independently or with minimal/moderate assistance (N=21). Intervention Six-week, group and community-based fall prevention and management intervention. The intervention included six 2-hour in-person weekly sessions led by a physical or occupational therapist featuring interactive group discussions, skill practice, and action planning opportunities. Main Outcome Measures Fall frequency tracked 12 weeks pre- and 24 weeks post intervention. Outcomes were assessed pre- and post intervention and 12 weeks post intervention. Measures included surveys to examine fear of falling (FOF), fall prevention/management, quality of life, community participation, and assessment of functional mobility skills. Semistructured interviews were administered post intervention to ascertain overall experiences with the program and effect on daily life. A Friedman test with signed-rank post hoc analysis was run to determine differences across the 3 study visits. Results After the intervention, fall incidence did not significantly change, but fall management strategies (P=.01-0.05), importance of community participation (P=.01), and transfer quality (P=.02) significantly improved. Moderate effect sizes were noted among concerns about falling, activity curtailment because of to FOF, and WC skills. Qualitative results indicate that participants found the intervention beneficial and applied intervention content in their daily lives. Conclusions This study is the first to describe the effect of a multicomponent fall prevention/management intervention designed specifically for PwMS who use a WC or scooter full-time. Results indicate the program has potential to reduce fall risk; however, further testing is needed to fully examine the effect of the program.
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Affiliation(s)
- Laura A. Rice
- Department of Kinesiology and Community Health, College of Applied Health Sciences, University of Illinois at Urbana-Champaign, Champaign, IL,College of Applied Health Sciences, Center on Health, Aging, and Disability, Champaign, IL,Corresponding author Laura A. Rice, PhD, MPT, ATP, 219 Freer Hall, 906 S. Goodwin Ave, Urbana, IL 61801
| | - Rebecca Yarnot
- Department of Kinesiology and Community Health, College of Applied Health Sciences, University of Illinois at Urbana-Champaign, Champaign, IL
| | - JongHun Sung
- Department of Kinesiology, Inha University, Incheon, Korea
| | - Jacob J. Sosnoff
- Department of Physical Therapy, Rehabilitation Science, and Athletic Training, University of Kansas Medical Center, Kansas City, KS
| | - Deborah Backus
- Virginia Crawford Research Institute, Shepherd Center, Atlanta, GA
| | - Libak Abou
- Department of Kinesiology and Community Health, College of Applied Health Sciences, University of Illinois at Urbana-Champaign, Champaign, IL,Department of Physical Medicine and Rehabilitation, Michigan Medicine, University of Michigan, Ann Arbor, MI
| | - Sa Shen
- College of Applied Health Sciences, Center on Health, Aging, and Disability, Champaign, IL
| | - Elizabeth W. Peterson
- Department of Occupational Therapy, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL
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Zanotto T, Rice LA, Sosnoff JJ. Frailty among people with multiple sclerosis who are wheelchair users. PLoS One 2022; 17:e0271688. [PMID: 35839220 PMCID: PMC9286252 DOI: 10.1371/journal.pone.0271688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 07/06/2022] [Indexed: 11/30/2022] Open
Abstract
Background Frailty is a biological syndrome arising from cumulative declines across multiple physiologic systems. Although recent reports have described elevated frailty levels in people with multiple sclerosis (MS) with minimal to moderate disability, very little is known about frailty in individuals with severe disability. The objective of the current investigation was to evaluate frailty through the deficit accumulation model and to explore the relationship of frailty with MS clinical subtypes, disease duration and fall-history in wheelchair users living with MS. Materials and methods Standard validated procedures were used to calculate a frailty index in 45 wheelchair and scooter users living with MS (median age = 60.0[16.0] years, 82.2% female, patient determined disease steps score = 7.0). Information on demographics, MS clinical subtypes, disease duration, and six-month fall-history were collected as part of a standardized medical survey. Results The mean frailty index score was 0.54 (standard deviation = 0.13). Overall, 91.1% and 8.9% of participants met objective diagnostic criteria for severe and moderate frailty, respectively. A one-way ANOVA revealed no significant differences (F = 0.054, p = 0.948) in the frailty index among participants with relapsing-remitting MS, primary progressive, and secondary progressive MS. No relationship between frailty and disease duration (r = -0.058, p = 0.706) was found. A univariable negative binomial regression analysis revealed a significant association between frailty index scores and the number of falls experienced in the previous six months (IRR = 1.75, 95% CI [1.06–2.91], p = 0.030). Conclusion The current study suggests that individuals with MS with advanced disability also live with coexisting frailty and that the frailty index may be a valuable tool in evaluating fall-risk in wheelchair users living with MS. The significant overlap observed between severe disability and severe frailty highlights the emerging need to untangle this bi-directional relationship to identify appropriate therapeutic pathways in the MS population living with advanced disability.
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Affiliation(s)
- Tobia Zanotto
- Department of Physical Therapy, Rehabilitation Science and Athletic Training, School of Health Professions, University of Kansas Medical Center, Kansas City, KS, United States of America
- Illinois Multiple Sclerosis Research Collaborative, Interdisciplinary Health Science Institute, University of Illinois at Urbana-Champaign, Urbana, IL, United States of America
- * E-mail:
| | - Laura A. Rice
- Illinois Multiple Sclerosis Research Collaborative, Interdisciplinary Health Science Institute, University of Illinois at Urbana-Champaign, Urbana, IL, United States of America
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, IL, United States of America
- Center on Health, Aging and Disability, University of Illinois at Urbana-Champaign, Urbana, IL, United States of America
| | - Jacob J. Sosnoff
- Department of Physical Therapy, Rehabilitation Science and Athletic Training, School of Health Professions, University of Kansas Medical Center, Kansas City, KS, United States of America
- Illinois Multiple Sclerosis Research Collaborative, Interdisciplinary Health Science Institute, University of Illinois at Urbana-Champaign, Urbana, IL, United States of America
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Kierkegaard M, Peterson E, Tuvemo Johnson S, Gottberg K, Johansson S, Elf M, Flink M, Ytterberg C. Online self-management fall prevention intervention for people with multiple sclerosis: a feasibility study protocol of a parallel group randomised trial. BMJ Open 2022; 12:e061325. [PMID: 35803627 PMCID: PMC9272100 DOI: 10.1136/bmjopen-2022-061325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Falls among people with multiple sclerosis (PwMS) are common and associated with injuries, fear of falling and low health-related quality of life. Considerations of behavioural, environmental, psychological and physical influences (including ambulation status) are needed to meet fall prevention needs for PwMS. Thus, using a codesign process involving key stakeholders a novel online self-management fall prevention intervention was created specifically for ambulatory and non-ambulatory PwMS. The feasibility, acceptability, fidelity and outcome of this complex intervention will be explored. Findings will inform a future full-scale randomised controlled trial. METHODS AND ANALYSIS A mixed-method design will be used. Forty-eight PwMS, stratified for ambulation level, will be randomised to control (n=24) or intervention (n=24). Both groups will receive a brochure about fall risk factors and fall prevention. The intervention is group-based (eight PwMS in each group); will be delivered online; and involve six, 2-hour weekly sessions and a booster session 8 weeks after the sixth session. Each intervention group will be led by a trained facilitator. Data collection will be performed at baseline, and after seven and 18 weeks. Outcome measures will capture data on fall prevention behaviours, fear of falling, falls self-efficacy, social and everyday activities, perceived impact of MS and number of falls. Feasibility of recruitment process, data collection procedures, outcome measures, and delivery, and intervention acceptability, fidelity and outcomes will be evaluated. Both quantitative and qualitative methods will be used. ETHICS AND DISSEMINATION Ethical approval has been obtained from the Swedish Ethical Review Authority (registration number 2021-04817). Results will be disseminated in peer-review journals, at conferences, research meetings, in social media and through the patient organisation Neuro Sweden. TRIAL REGISTRATION NUMBER NCT04317716.
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Affiliation(s)
- Marie Kierkegaard
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Academic Specialist Center, Region Stockholm, Stockholm, Sweden
| | - Elizabeth Peterson
- Department of Occupational Therapy, College of Applied Health Sciences, University of Illinois Chicago, Chicago, IL, USA
| | - Susanna Tuvemo Johnson
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Kristina Gottberg
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Sverker Johansson
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Women's Health and Allied Health Professionals Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Marie Elf
- School of Education and Learning, Dalarna University, Falun, Sweden
| | - Maria Flink
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Women's Health and Allied Health Professionals Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Charlotte Ytterberg
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Women's Health and Allied Health Professionals Theme, Karolinska University Hospital, Stockholm, Sweden
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Abou L, Sosnoff JJ, Peterson EW, Backus D, Willingham TB, Rice LA. Prediction of future falls among full-time wheelchair and scooter users with multiple sclerosis: A prospective study. Mult Scler Relat Disord 2022; 64:103962. [PMID: 35716478 DOI: 10.1016/j.msard.2022.103962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Revised: 05/23/2022] [Accepted: 06/10/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Seventy-five percent (75%) of full-time wheelchair or scooter users with multiple sclerosis (MS) experience at least one fall in a period of 6 months. Falls are detrimental for the independence, quality of life, and community participation. No previous prospective study has evaluated fall risk factors in this segment of MS community. OBJECTIVE To develop a multivariable falls risk prediction model for people with MS (PwMS) who use a wheelchair or scooter full-time. METHODS This prospective cohort study is a secondary data analysis that recruited PwMS from the community across the US. Forty-eight adults with MS who use a wheelchair or scooter as their main form of mobility were included. Dependent variable was fall incidence over 3-month recorded through diaries. Dependent variable was categorized as fallers (≥ 1 fall) and non-fallers (0 fall). Predictors were demographics, history of falls in the past 6 months, measures of fear of falling, Spinal Cord Injury- Falls Concern Scale, California Verbal Learning Test II, and Multiple Sclerosis Quality of Life- mental health. Multivariable logistic regression analyses were conducted to identity predictors of future falls. RESULTS In total, 63 falls (range 0 - 8) were reported over the 3-month period from a total of 26 fallers (54%). Multivariate logistic regression analyses indicated that the risk factor with the best predictive ability of future falls included history of falls in the past 6 months (sensitivity 77%, specificity 54%, and area under the receiving operating curve statistic = 0.76, 95% CI 0.62 to 0.89). CONCLUSION Findings highlight the importance of asking full-time wheelchair and scooter users with MS if they have fallen in the past 6 months to quickly identify those who are at increased fall risk and in need of follow up assessment and intervention to identify and address modifiable risk factors. More attention to fall risks among full-time wheelchair or scooter users with MS is suggested to increase the understanding among clinicians and researchers of modifiable risk factors.
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Affiliation(s)
- Libak Abou
- Department of Kinesiology and Community Health, College of Applied Health Sciences, University of Illinois at Urbana-Champaign, 219 Freer Hall, 906 S. Goodwin Ave., Urbana, IL 61801, USA. https://twitter.com/https://twitter.com/libak9
| | - Jacob J Sosnoff
- Department of Physical Therapy, Rehabilitation Science, and Athletic Training, University of Kansas Medical Center, Kansas City, KS, USA
| | - Elizabeth W Peterson
- Department of Occupational Therapy, College of Applied Health Sciences, University of Illinois Chicago, Chicago, IL, USA
| | - Deborah Backus
- Virginia Crawford Research Institute, Shepherd Center, Atlanta, GA, USA
| | | | - Laura A Rice
- Department of Kinesiology and Community Health, College of Applied Health Sciences, University of Illinois at Urbana-Champaign, 219 Freer Hall, 906 S. Goodwin Ave., Urbana, IL 61801, USA; Center on Health, Aging, and Disability, College of Applied Health Sciences, Champaign, IL, USA.
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Rice LA, Peters J, Fliflet A, Sung J, Rice IM. The influence of shoulder pain and fear of falling on level and non-level transfer technique. J Spinal Cord Med 2022; 45:364-372. [PMID: 35007474 PMCID: PMC9135433 DOI: 10.1080/10790268.2021.1971922] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Level and non-level transfers are essential tasks of daily living for wheelchair users. Minimal research has examined the role of shoulder pain and fear of falling on transfer quality. The purpose of this study is to (1) examine the association between shoulder pain, fear of falling (FoF) and transfer quality and (2) explore the feasibility of assessing non-level transfers to-and-from the floor. METHODS Cross-sectional design was used to explore shoulder pain, FoF, and transfer quality in 30 manual wheelchair users (aged 18-42; 15 males). Participant demographic information (age, sex, race, disability, and years using wheelchair), Spinal Cord Injury-Fall Concern Scale (SCI-FCS), and Wheelchair User Shoulder Pain Index (WUSPI) was collected. Three types of transfers: (1) level, (2) uphill, and (3) floor-to-table were graded by a trained researcher using the Transfer Assessment Instrument (TAI) 3.0. Kruskal-Wallis test was used to determine differences in transfer quality based on condition. Spearman correlation was used to determine associations between demographic data, WUSPI, SCI-FCS, and transfer quality scores. RESULTS All participants safely completed the uphill non-level transfer; 27 safely completed the floor-to-table non-level transfer. Statistical analysis revealed no difference in TAI score across transfer conditions. Spearman correlation revealed a significant correlation between WUSPI and SCI-FCS scores (r = .68, P = .01) and WUSPI and uphill TAI scores (r = -.45, P = .01). CONCLUSION Increases in shoulder pain are related to decreased uphill transfer quality and increased FoF. Non-level transfers to-and-from the floor are feasible within clinical or laboratory settings.
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Affiliation(s)
- Laura A. Rice
- Department of Kinesiology and Community Health, College of Applied Health Sciences, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA
| | - Joseph Peters
- Department of Kinesiology and Community Health, College of Applied Health Sciences, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA
| | - Alex Fliflet
- Department of Kinesiology and Community Health, College of Applied Health Sciences, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA
| | - JongHun Sung
- Department of Human Performance and Sport Studies, College of Education, Idaho State University, Pocatello, Idaho, USA
| | - Ian M. Rice
- Department of Kinesiology and Community Health, College of Applied Health Sciences, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA
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Mortenson WB, Routhier F, Mahmood A, Prescott M, Labbé D, Martin Ginis KA, Miller WC. Predictors of Psychological Distress and Confidence Negotiating Physical and Social Environments Among Mobility Device Users. Am J Phys Med Rehabil 2022; 101:324-330. [PMID: 34050064 DOI: 10.1097/phm.0000000000001816] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE We conducted an intersectional analysis to explore how demographic characteristics and mobility device use were associated with psychological distress (depression and anxiety) and confidence negotiating physical and social environments. DESIGN Cross-sectional data were collected using the Hospital Anxiety and Depression Scale, modified Wheelchair Use Confidence Scale, and self-reported functional independence scale. PARTICIPANTS The sample included 105 participants. Primary mobility devices used included mobility scooters (27%), power wheelchairs (26%), manual wheelchairs (25%), walkers (11%), and cane or crutch (12%). The mean age of participants was 58 yrs, 53% were female, and 52% lived alone and were functionally independent with the use of assistive technology. RESULTS We were able to explain between 39% and 65% of the variance (adjusted R2) in the dependent variables with parsimonious regression models. Age was an independent predictor of all outcomes. Women were less confident negotiating the physical environment, and walker use was associated with depression and lower confidence negotiating physical environments, but increased confidence negotiating social environments. CONCLUSIONS Age is associated with psychosocial outcomes for assistive device users, and those who use walkers may experience increased challenges with depression and negotiating the physical environment. Pending confirmatory research, the findings may have important implications for targeted interventions related to device provision.
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Affiliation(s)
- W Ben Mortenson
- From the Department of Occupational Sciences and Occupational Therapy, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada (WBM, MP, DL, WCM); International Collaboration on Repair Discoveries (ICORD), Vancouver, British Columbia, Canada (WBM); Rehabilitation Research Program, Vancouver Coastal Health Research Institute (VCHRI), Vancouver, British Columbia, Canada (WBM, MP, DL, WCM); Department of Rehabilitation, Faculty of Medicine, Université Laval, Québec, Québec, Canada (FR); Centre interdisciplinaire de recherche en réadaptation et en intégration sociale, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Québec, Québec, Canada (FR); Department of Gerontology, Faculty of Arts and Social Sciences, Simon Fraser University, Burnaby, British Columbia, Canada (AM); Disability and Human Development Department, University of Illinois at Chicago, Chicago, Illinois (DL); Reichwald Family UBC Southern Medical Program Chair in Preventive Medicine, Vancouver, British Columbia, Canada (KAM); and Department of Medicine, Faculty of Medicine, School of Health and Exercise Sciences, Centre for Chronic Disease Prevention and Management, University of British Columbia, Kelowna, British Columbia, Canada (KAM)
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22
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3D finite-element modeling of air-cell-based cushions and buttock tissues during prolonged sitting. Comput Biol Med 2022; 142:105229. [DOI: 10.1016/j.compbiomed.2022.105229] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 12/21/2021] [Accepted: 01/06/2022] [Indexed: 11/17/2022]
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23
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Rice LA, Yarnot R, Peterson EW, Backus D, Sosnoff J. Fall Prevention for People With Multiple Sclerosis Who Use Wheelchairs and Scooters. Arch Phys Med Rehabil 2021; 102:801-804. [PMID: 33461727 DOI: 10.1016/j.apmr.2020.10.107] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 10/01/2020] [Indexed: 11/26/2022]
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Fear of Falling, Community Participation, and Quality of Life Among Community-Dwelling People Who Use Wheelchairs Full Time. Arch Phys Med Rehabil 2020; 102:1140-1146. [PMID: 33347892 DOI: 10.1016/j.apmr.2020.11.013] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 11/15/2020] [Accepted: 11/16/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVES To examine the differences in community participation and quality of life (QOL) among individuals who use wheelchairs full time with and without fear of falling (FOF). DESIGN Cross-sectional study design. SETTING University research laboratory. PARTICIPANTS Individuals (N=85) who use a manual or power wheelchair full time who are living with various health conditions and have a history of at least 1 fall in the past 12 months (age, 45.4±15.8y; disability duration, 21.5±13.6y) were included. Forty-six (54%) were manual wheelchair users. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES To quantify FOF, participants responded (yes/no) to the question: "Are you worried or concerned that you might fall?" Community participation and QOL were indexed by the Community Participation Indicator (CPI) and the World Health Organization Quality of Life-Brief version (WHOQOL-BREF), respectively. A multivariate analysis of variance (MANOVA) was performed to examine the differences in CPI and WHOQOL-BREF scores among wheelchair users who reported FOF and no FOF. RESULTS A total of 54 participants (63.5%) reported that they were worried or concerned about falling. The MANOVA revealed significant differences in overall CPI (F2,82=4.714; P=.012; Wilks' λ=0.897) and WHOQOL-BREF (F4,63=3.32; P=.016; Wilks' λ=.826) scores. Participants who reported FOF demonstrated significantly lower CPI and WHOQOL-BREF scores compared with those who did not report FOF. CONCLUSIONS FOF and associated activity curtailment are prevalent and may be a factor influencing full time wheelchair users' community participation and QOL. Prospective research is needed to better understand how FOF influences community participation and QOL among individuals who use wheelchairs full time. Findings would support the development of interventions, specifically for individuals who use wheelchairs full time, to reduce FOF and improve community participation and QOL.
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25
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Pelicioni PHS, Schulz-Moore JS, Hale L, Canning CG, Lord SR. Lockdown During COVID-19 and the Increase of Frailty in People With Neurological Conditions. Front Neurol 2020; 11:604299. [PMID: 33304316 PMCID: PMC7701276 DOI: 10.3389/fneur.2020.604299] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 10/19/2020] [Indexed: 12/11/2022] Open
Abstract
Governments around the globe have introduced quarantine, lockdown, and mandatory isolation to slow the transmission of COVID-19. These public health and policy measures aim to protect the public and vulnerable people. This perspective paper argues that the impacts of lockdown (such as social disconnection, reduced exercise, and fewer physiotherapy treatments) may be amplified for people with neurological conditions with subsequent increases in frailty. The paper outlines why this may occur, and explores how adverse impacts for these vulnerable populations may be minimized through strategies such as telehealth, exercise programs, and health policies.
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Affiliation(s)
- Paulo H S Pelicioni
- Neuroscience Research Australia, University of New South Wales, Sydney, NSW, Australia
| | - Jennifer S Schulz-Moore
- Faculty of Law, University of New South Wales, Sydney, NSW, Australia.,School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Leigh Hale
- School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Colleen G Canning
- Discipline of Physiotherapy, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Stephen R Lord
- Neuroscience Research Australia, University of New South Wales, Sydney, NSW, Australia.,School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW, Australia
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Coote S, Comber L, Quinn G, Santoyo-Medina C, Kalron A, Gunn H. Falls in People with Multiple Sclerosis: Risk Identification, Intervention, and Future Directions. Int J MS Care 2020; 22:247-255. [PMID: 33424479 DOI: 10.7224/1537-2073.2020-014] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Falls are highly prevalent in people with multiple sclerosis (MS) and result in a range of negative consequences, such as injury, activity curtailment, reduced quality of life, and increased need for care and time off work. This narrative review aims to summarize key literature and to discuss future work needed in the area of fall prevention for people with MS. The incidence of falls in people with MS is estimated to be more than 50%, similar to that in adults older than 80 years. The consequences of falls are considerable because rate of injury is high, and fear of falling and low self-efficacy are significant problems that lead to activity curtailment. A wide range of physiological, personal, and environmental factors have been highlighted as potential risk factors and predictors of falls. Falls are individual and multifactorial, and, hence, approaches to interventions will likely need to adopt a multifactorial approach. However, the literature to date has largely focused on exercise-based interventions, with newer, more comprehensive interventions that use both education and exercise showing promising results. Several gaps in knowledge of falls in MS remain, in particular the lack of standardized definitions and outcome measures, to enable data pooling and comparison. Moving forward, the involvement of people with MS in the design and evaluation of programs is essential, as are approaches to intervention development that consider implementation from the outset.
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Perspectives of wheelchair users with spinal cord injury on fall circumstances and fall prevention: A mixed methods approach using photovoice. PLoS One 2020; 15:e0238116. [PMID: 32857793 PMCID: PMC7454945 DOI: 10.1371/journal.pone.0238116] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 08/09/2020] [Indexed: 11/28/2022] Open
Abstract
Introduction Wheelchair users with spinal cord injury are at a high risk of falls. However, the perspectives of wheelchair users with spinal cord injury on their fall circumstances and their preferences for fall prevention strategies/interventions remain understudied. Therefore, we aimed to: a) describe the circumstances of falls experienced by wheelchair users with spinal cord injury over a six-month period, b) explore their perspectives of why falls occurred in certain situations, and c) explore their perspectives on recommended content/structure of fall prevention strategies/interventions. Methods This sequential explanatory mixed methods study had two phases. Phase I involved tracking of falls experienced by wheelchair users with spinal cord injury over six months, in which participants completed a survey after experiencing a fall to track the number/circumstance of each fall. Data from the surveys were descriptively reported. Phase II involved a photovoice focus group discussion of the survey findings and their preferences for fall prevention strategies/interventions. Data from the focus group discussion were analyzed using a thematic analysis. Results Thirty-two participants completed phase I. More than half of the participants fell at least once in six months. Falls commonly occurred in the afternoon during a transfer, or when participants were wheeling over uneven ground. One-third of the falls caused an injury. Eleven participants that fell during phase I participated in the focus group. Two main themes were identified from the discussion: 1) “circumstances surrounding the falls” (e.g. when falls occurred, the home is a ‘safe space’) and 2) “suggestions and preferences for fall prevention strategies/interventions” (e.g. fall prevention involves all, fall prevention training available as needed). Conclusion Fall prevention strategies/interventions should be an integral component of rehabilitation practices across the lifespan. Participants recommend customizing fall prevention strategies/interventions to their specific needs to guide the structure, content, and delivery of targeted fall prevention programs.
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Manis DR, McArthur C, Costa AP. Associations with rates of falls among home care clients in Ontario, Canada: a population-based, cross-sectional study. BMC Geriatr 2020; 20:80. [PMID: 32106824 PMCID: PMC7047389 DOI: 10.1186/s12877-020-1483-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Accepted: 02/17/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Accidental falls among older adults are a leading cause of injury-related hospitalizations. Reducing falls is an ongoing quality improvement priority for home care, given that many home care clients experience falls. In this study, we identify factors associated with the rate of falls among home care clients. METHODS We conducted a population-based, cross-sectional study using secondary data from the Hamilton, Niagara, Haldimand, and Brant health region of Ontario, Canada from January 1 - March 31, 2018. We captured person-level characteristics with falls from the Resident Assessment Instrument - Home Care (RAI-HC). Negative binomial regression was used to model the rate of falls. RESULTS Functional characteristics of home care clients had strong, statistically significant associations with the rate of falls. Declines in activities of daily living, assistive device use for locomotion indoors, polypharmacy, and health conditions, such as dizziness or lightheadedness, and parkinsonism, were associated with a higher rate of falls. Males who used assistive devices had a higher rate of falls compared to females; however, males with neurological and cardiovascular health conditions had a decrease in the rate of falls compared to females. Home care clients with parkinsonism who used a cane and took eight or more drugs had stronger associations with an increased rate of falls compared to those who do not have parkinsonism. CONCLUSIONS Functional characteristics, polypharmacy, and health conditions are associated with increased rates of falls among home care clients. Home care clients who are at a greater risk of falls may require environmental adjustments in their home to reduce or eliminate the possibility of falling.
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Affiliation(s)
- Derek R Manis
- Centre for Health Economics and Policy Analysis, McMaster University, 1280 Main Street West, CRL-201, Hamilton, ON, L8S 4K1, Canada. .,Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada.
| | - Caitlin McArthur
- Department of Medicine, McMaster University, Hamilton, Canada.,GERAS Centre for Aging Research, McMaster University, Hamilton, Canada
| | - Andrew P Costa
- Centre for Health Economics and Policy Analysis, McMaster University, 1280 Main Street West, CRL-201, Hamilton, ON, L8S 4K1, Canada.,Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada.,Department of Medicine, McMaster University, Hamilton, Canada
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Matsuda PN, Eagen T, Hreha KP, Finlayson ML, Molton IR. Relationship Between Fear of Falling and Physical Activity in People Aging With a Disability. PM R 2019; 12:454-461. [DOI: 10.1002/pmrj.12289] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Accepted: 11/04/2019] [Indexed: 12/28/2022]
Affiliation(s)
| | - Thomas Eagen
- Department of Rehabilitation MedicineUniversity of Washington Seattle WA
| | - Kimberly P. Hreha
- Division of Rehabilitation SciencesUniversity of Texas Medical Branch at Galveston Galveston TX
| | | | - Ivan R. Molton
- Department of Rehabilitation MedicineUniversity of Washington Seattle WA
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30
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Rice LA, Peters J, Sung J, Bartlo WD, Sosnoff JJ. Perceptions of Fall Circumstances, Recovery Methods, and Community Participation in Manual Wheelchair Users. Am J Phys Med Rehabil 2019; 98:649-656. [PMID: 31318744 DOI: 10.1097/phm.0000000000001161] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of the study was to examine the circumstances surrounding the worst fall experienced by full-time manual wheelchair users in the past 12 mos, the recovery process, and influence on community participation. DESIGN A mixed-method research study was conducted. Semistructured interviews were conducted to understand the circumstances of the worst fall experienced and the recovery process. A quantitative fear of falling assessment and the community participation indicators were used to further evaluate the influence of the fall. RESULTS There were 20 manual wheelchair users (mean ± SD, 47 ± 13 yrs, 55% male). Falls most commonly occurred outside during wheelchair propulsion. Falls were attributed to both intrinsic and extrinsic factors. Seventy percent of participants reported a fear of falling and 80% required assistance to recovery. No significant correlations were found between fall frequency and community participation indicator scores. Participants who needed assistance to recover (56.70 ± 17.66) had lower community participation indicator importance scores compared with participants able to recover independently (88.93 ± 22.13), P = 0.05. CONCLUSIONS Falls are complex and most manual wheelchair users need assistance to recover. Comprehensive programs including education on prevention and postfall management are needed. Results may increase understanding of the circumstances associated with falls and inform the development of evidenced-based clinical practice guidelines.
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Affiliation(s)
- Laura A Rice
- From the Department of Kinesiology and Community Health, College of Applied Health Sciences, University of Illinois at Urbana-Champaign, Urbana, Illinois (LAR, JP, JHS, JJS); and Center on Health, Aging, and Disability, College of Applied Health Sciences, University of Illinois at Urbana-Champaign, Urbana, Illinois (WDB, JJS)
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31
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Zhao S, Cao Y, Lei Y, Liu F, Shao S, Liu J, Nie D, Yang N, Liu M. Population ageing and injurious falls among one million elderly people who used emergency medical services from 2010 to 2017 in Beijing, China: a longitudinal observational study. BMJ Open 2019; 9:e028292. [PMID: 31256032 PMCID: PMC6609050 DOI: 10.1136/bmjopen-2018-028292] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES To access the epidemiological characteristics of elderly people using emergency medical services (EMS) in Beijing, as a consequence of injurious falls, and the association between an ageing population and injurious falls. DESIGN A longitudinal observational study based on Beijing EMS data. SETTING All citizens aged 60 years or above who used EMS from 2010 to 2017 in Beijing, China. PARTICIPANTS During 2010 to 2017, 2516 128 people used EMS in Beijing. Of these, 1528 938 people aged under 60 years were excluded and the remaining 987 190 people were included in our study. METHODS Data were from the emergency dispatch database of Beijing's Emergency Medical Centre. We described the proportion of elderly people using EMS in Beijing due to injurious falls with regard to region, time, sex, age and proportion of the elderly population. RESULTS Among the 987 190 participants who used EMS, 82 694 (8.38%) had had a fall. The proportion of falls rose from 7.12% in 2010 to 9.45% in 2017, and was higher in urban (8.62%) than in suburban (7.80%) regions. Elderly people were more likely to use EMS due to injurious falls during September to November (8.99%) than during December to February (7.68%) (adjusted OR (aOR)=1.19), and during 08:00 to 09:59 (10.02%) than during 00:00 to 01:59 (4.11%) (aOR=2.52). Elderly people in districts with high (8.92%, aOR=1.15) and medium (8.23%, aOR=1.09) proportions of an elderly population were more likely to use EMS due to injurious falls than those in districts with a low proportion of elderly population (7.81%). CONCLUSIONS In Beijing, the proportion of elderly people using EMS due to injurious falls increased with age, and was positively correlated with the proportion of the elderly population. Taking care of elderly people and preventing injurious falls should be one of the key issues to be handled in a society with an ageing population.
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Affiliation(s)
- Siyu Zhao
- Department of Epidemiology & Biostatistics, Peking University, School of Public Health, Beijing, China
| | - Yu Cao
- Emergency office, Beijing Municipal Commission of Health and Family Planning, Beijing, China
| | - Yanni Lei
- 120 Command and Dispatch Center, Beijing Emergency Medical Center, Beijing, China
| | - Fangchao Liu
- Department of Epidemiology & Biostatistics, Peking University, School of Public Health, Beijing, China
| | - Shiyu Shao
- 120 Command and Dispatch Center, Beijing Emergency Medical Center, Beijing, China
| | - Jue Liu
- Department of Epidemiology & Biostatistics, Peking University, School of Public Health, Beijing, China
| | - Dongni Nie
- 120 Command and Dispatch Center, Beijing Emergency Medical Center, Beijing, China
| | - Nannan Yang
- 120 Command and Dispatch Center, Beijing Emergency Medical Center, Beijing, China
| | - Min Liu
- Department of Epidemiology & Biostatistics, Peking University, School of Public Health, Beijing, China
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Sung J, Trace Y, Peterson EW, Sosnoff JJ, Rice LA. Falls among full-time wheelchair users with spinal cord injury and multiple sclerosis: a comparison of characteristics of fallers and circumstances of falls. Disabil Rehabil 2019; 41:389-395. [PMID: 29069956 DOI: 10.1080/09638288.2017.1393111] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Revised: 10/09/2017] [Accepted: 10/12/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE The purpose of this study is to (1) explore and (2) compare circumstances of falls among full-time wheelchair users with spinal cord injury (SCI) and multiple sclerosis (MS). METHODS A mixed method approach was used to explore and compare the circumstances of falls of 41 full-time wheelchair users with SCI (n = 23) and MS (n = 18). In addition to collecting participants' demographic information (age, gender, type of wheelchair used, duration of wheelchair use, and duration of disability), self-reported fall frequency in the past 6 months, self-reported restriction in activity due to fear of falling and the Spinal Cord Injury-Fall Concerns Scale (SCI-FCS) was collected. Qualitative data in the form of participants' responses to an open-ended question yielding information regarding the circumstances of the most recent fall were also collected. To examine differences in survey outcomes and demographic characteristics between participants with SCI and MS, independent t-tests and Pearson's Chi-square tests were used. Qualitative data were analyzed with a thematic analysis. RESULTS Statistical analysis revealed that individuals with MS (mean =3.3) had significantly higher average SCI-FCS than individuals with SCI (mean =2.4). The analysis of the participants' descriptions of the circumstances of their most recent falls resulted in three main categories: action-related fall contributors (e.g., transfer), (2) location of falls (e.g., bathroom), and (3) fall attributions (e.g., surface condition). CONCLUSIONS The results from this study helped to understand fall circumstances among full-time wheelchair users with MS and SCI. Findings from this study can inform the development of evidenced-based interventions to improve the effectiveness of clinically based treatment protocols. Implications for rehabilitation Falls are a common health concern in full-time wheelchair users living with multiple sclerosis and spinal cord injury. The circumstances surrounding falls reported by full-time wheelchair users living with multiple sclerosis and spinal cord injuries were found to be multifactorial. The complex nature of falls must be taken into consideration in the development of fall prevention programs. Findings from this study can inform the development of comprehensive evidence-based, population-specific interventions to manage falls among full-time wheelchair users living with multiple sclerosis and spinal cord injury.
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Affiliation(s)
- JongHun Sung
- a Department of Kinesiology and Community Health , University of Illinois at Urbana , Urbana, IL , USA
| | - Yarden Trace
- a Department of Kinesiology and Community Health , University of Illinois at Urbana , Urbana, IL , USA
| | - Elizabeth W Peterson
- b Department of Occupational Therapy , University of Illinois at Chicago , Chicago , IL , USA
| | - Jacob J Sosnoff
- a Department of Kinesiology and Community Health , University of Illinois at Urbana , Urbana, IL , USA
| | - Laura A Rice
- a Department of Kinesiology and Community Health , University of Illinois at Urbana , Urbana, IL , USA
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Rice LA, Sung J, Peters J, Bartlo WD, Sosnoff JJ. Perceptions of fall circumstances, injuries and recovery techniques among power wheelchair users: a qualitative study. Clin Rehabil 2018; 32:985-993. [PMID: 29627995 DOI: 10.1177/0269215518768385] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2024]
Abstract
OBJECTIVE To understand the circumstances surrounding the worst fall experienced by power wheelchair users in the past year and to examine injuries sustained and recovery methods. DESIGN A qualitative study using a semi-structured interview. SETTING Community. PARTICIPANTS A self-selected volunteer sample of 19 power wheelchair users who utilize their device for at least 75% of mobility. The most common disability represented was cerebral palsy ( n = 8). The mean (SD) age of participants was 41.9 (7.6) years, who lived with their disability for a mean (SD) of 20.5 (8.62) years and used their current device for a mean (SD) of 3.9 (1.9) years. INTERVENTION None. MAIN OUTCOME MEASURES A semi-structured interview examined the circumstances surrounding the worst fall experienced in the past year, injuries sustained and recovery techniques used. RESULTS Upon examination of the circumstances of the worst fall, four main themes emerged: (1) action-related fall contributors, (2) location of falls, (3) fall attributions and (4) time of fall. Each fall described was found to involve multiple factors. As a result of the fall, participants also reported the occurrence of physical injuries and a fear of falling. Physical injuries ranged from skin abrasion and bruises to fractures and head injuries. Participants also reported that fear of falling diminished their desire to participation in activities they enjoyed doing. Finally, most participants reported the need for physical assistance to recover from a fall. CONCLUSION Participant descriptions provide an in-depth description of the circumstances and aftermath of falls experienced by power wheelchair users.
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Affiliation(s)
- Laura A Rice
- 1 Department of Kinesiology and Community Health, College of Applied Health Sciences, University of Illinois at Urbana-Champaign, Champaign, IL, USA
| | - JongHun Sung
- 1 Department of Kinesiology and Community Health, College of Applied Health Sciences, University of Illinois at Urbana-Champaign, Champaign, IL, USA
| | - Joseph Peters
- 1 Department of Kinesiology and Community Health, College of Applied Health Sciences, University of Illinois at Urbana-Champaign, Champaign, IL, USA
| | - Wendy D Bartlo
- 2 The Center on Health, Aging, and Disability, College of Applied Health Sciences, University of Illinois at Urbana-Champaign, Champaign, IL, USA
| | - Jacob J Sosnoff
- 1 Department of Kinesiology and Community Health, College of Applied Health Sciences, University of Illinois at Urbana-Champaign, Champaign, IL, USA
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Rice LA, Abou L, Denend TV, Peterson EW, Sosnoff JJ. Falls Among Wheelchair and Scooter Users with Multiple Sclerosis—A Review. ACTA ACUST UNITED AC 2018. [DOI: 10.17925/usn.2018.14.2.82] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Falls are increasingly recognized as a threat to the safety, health and well-being of people with multiple sclerosis (MS), and emerging evidence suggests that full time wheelchair and scooter users with MS have unique fall prevention needs. This review is comprised of three parts. Part 1 summarizes findings describing influences on falls among full time wheelchair and scooter users with MS and associated clinical implications. Although further studies are needed, early findings regarding influences on fall risk operating in this specific population highlight the importance of addressing falls that occur during activities of daily living, the high frequency of falls occurring in the bathroom, and both extrinsic (e.g., wet/slippery surfaces) and intrinsic (e.g., muscle spasticity/weakness) contributors to falls. Part 2 of this review describes available evidence regarding interventions to prevent falls in full time wheelchair and scooter users with MS. Because intervention work in this area is limited to one pilot study, Part 3 presents priorities for future research and identifies the need for randomized trials evaluating fall prevention programs that address diverse fall risk factors and allow for development and attainment of individualized fall prevention goals.
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