Risk factors for falling for people with Multiple Sclerosis identified in a prospective cohort study

The effect of exercise and physical activity-interventions on step count and intensity level in individuals with multiple sclerosis: a systematic review and meta-analysis of randomized controlled trials

Background

Reduced physical activity is a worldwide challenge in individuals with multiple sclerosis (MS). The aim of this systematic review and meta-analysis was to identify devise-measured effects of physical activity, exercise and physiotherapy-interventions on step count and intensity level of physical activity in individuals with MS.

Methods

A systematic search of the databases of PubMed (including Medline), Scopus, CINHAL and Web of Science was carried out to retrieve studies published in the English language from the inception to the first of May 2023. All trials concerning the effectiveness of different types of exercise on step count and intensity level in people with MS were included. The quality of the included studies and their risk of bias were critically appraised using The modified consolidated standards of reporting trials and the Cochrane Risk of Bias tool, respectively. The pooled standardized mean difference (SMD) and 95% CI of the step-count outcome and moderate to vigorous intensity level before versus after treatment were estimated in both Intervention and Control groups using the random effect model. The Harbord test were used to account for heterogeneity between studies and assess publication bias, respectively. Further sensitivity analysis helped with the verification of the reliability and stability of our review results.

Results

A total of 8 randomized clinical trials (involving 919 individuals with MS) were included. The participants (including 715 (77.8%) female and 204 (22.2%) male) had been randomly assigned to the Intervention (n = 493) or Control group (n = 426). The pooled mean (95% CI) age and BMI of participants were 49.4 years (95% CI: 47.4, 51.4 years) and 27.7 kg/m2 (95% CI: 26.4, 29 kg/m2), respectively. In terms of the comparison within the Intervention and the Control groups before and after the intervention, the results of the meta-analysis indicate that the pooled standardized mean difference (SMD) for step-count in the Intervention group was 0.56 (95% CI: -0.42, 1.54), while in the Control group it was 0.12 (95% CI: -0.05, 0.28). Furthermore, there was no significant difference in the pooled SMD of step-count in the physical activity Intervention group compared to the Controls after the intervention (pooled standard mean difference = 0.19, 95% CI: -0.36,0.74). Subgroup analysis on moderate to vigorous intensity level of physical activity revealed no significant effect of the physical activity intervention in the Intervention group compared to the Control group after the intervention, or within groups before and after the intervention. Results of meta regression showed that age, BMI, duration of disease and Expanded Disability Status Scale (EDSS) score were not the potential sources of heterogeneity (all p > 0.05). Data on the potential harms of the interventions were limited.

Conclusion

The results of this meta-analysis showed no significant differences in step count and moderate to vigorous physical activity level among individuals with MS, both within and between groups receiving physical activity interventions. More studies that objectively measure physical activity are needed.

Systematic Review Registration

https://www.crd.york.ac.uk/prospero/, identifier: CRD42022343621.

Effect of Dynamic Neuromuscular Stabilization on Balance, Trunk Function, Falling, and Spasticity in People With Multiple Sclerosis: A Randomized Controlled Trial

OBJECTIVE

To compare the effects of core stabilization (CS) and dynamic neuromuscular stabilization (DNS) on balance, trunk function, mobility, falling, and spasticity, in people with multiple sclerosis (PWMS).

DESIGN

Two-group randomized controlled trial.

SETTING

General community and referral center.

PARTICIPANTS

A total of 64 PWMS, between 30 and 50 years old, and an expanded disability status scale between 2 and 5, participated in this study (N=64).

INTERVENTIONS

Participants were randomly assigned to CS (n=32) and DNS (n=32) groups. Both groups received a total of 15 sessions of CS or DNS exercises, 60 minutes per session, 3 times a week during the 5 weeks.

OUTCOME MEASURES

Balance function was measured as the primary outcome measure. Trunk function, postural stability, falling rate, fear of falling, falling index, mobility, and spasticity were measured as secondary outcomes.

RESULTS

DNS group had significant improvement in Berg balance scale, trunk impairment scale, postural stability, activities-specific balance confidence, reduced falling rate, the timed Up and Go (TUG), multiple sclerosis walking scale-12, and multiple sclerosis spasticity scale in PWMS compared with the CS group, (P<.0001) after 5 weeks of intervention and 17 weeks of follow-up. Except for the modified Ashworth scale (MAS), significant improvements were seen in all outcome measures in both groups after 5 weeks of intervention.

CONCLUSION

This is the first clinical evidence to support the importance of DNS exercise in improving balance, trunk function, and fall prevention in PWMS. This study provides clinical evidence that DNS may be more effective for PWMS than CS.

Motor Cognitive Dual-Task Testing to Predict Future Falls in Multiple Sclerosis: A Systematic Review

BACKGROUND

Mobility and cognitive impairments are often associated with increased fall risk among people with multiple sclerosis (PwMS). However, evidence on the concurrent assessment of gait or balance and cognitive tasks (dual-task) to predict falls appears to be inconsistent.

OBJECTIVE

To summarize the ability of gait or balance dual-task testing to predict future falls among PwMS.

METHODS

Seven databases including PubMed, Embase, Web of Science, Scopus, CINHAL, SPORTDiscuss, and PsycINFO were searched from inception to May 2022. Two independent reviewers identified studies that performed a dual-task testing among adults with multiple sclerosis and monitored falls prospectively for at least 3 months. Both reviewers also evaluated the quality assessment of the included studies.

RESULTS

Eight studies with 484 participants were included in the review. Most studies (75%) indicated that dual-task testing and dual-task cost did not discriminate prospective fallers (⩾1 fall) and non-fallers (0 fall) and were not found as predictors of future falls. However, dual-task cost of walking velocity (OR = 1.23, 95% CI 0.98-4.45, P = .05) and dual-task of correct response rate of serial 7 subtraction (OR = 1.34, 95% CI 1.04-3.74, P = .02) were significantly associated with increased risk of recurrent falls (≥2 falls). Pattern of cognitive-motor interference was also associated with an increased risk of falling. All studies presented with strong quality.

CONCLUSION

The scarce evidence indicates that dual-task testing is not able to predict future falls among PwMS. Further research with more complex motor and cognitive tasks and longer-term fall monitoring is required before dual-task testing can be recommended as a predictor of future falls in this population.

Examining the Relationship Between Reactive Stepping Outcomes and Falls in People With Multiple Sclerosis

OBJECTIVE

Reactive stepping is critical for preventing falls and is impaired in people with multiple sclerosis (PwMS); however, which aspects of stepping relate to falls remains poorly understood. Identifying outcomes most related to falls is a first step toward improving rehabilitation for fall prevention. The purpose of this study was to assess whether reactive step latency or length during forward and backward losses of balance were related to a history of falls in PwMS.

METHODS

Of the 111 PwMS who participated in this study, 76 reported no falls in the previous 6 months, whereas 36 reported 1 or more falls. Participants completed 3 forward and 3 backward treadmill-induced reactive steps from stance. Step length (centimeters) and step latency (milliseconds) were measured using motion capture and analyzed via MATLAB.

RESULTS

Participants with a history of falls had significantly slower step latencies during backward stepping, but not forward stepping, than those without a history of falls. Step length did not differ between groups. Slower step latencies during backward stepping significantly increased the odds of having experienced a fall (β = .908, SE = 0.403, odds ratio = 2.479, 95% CI = 1.125 to 5.464).

CONCLUSION

PwMS and a history of falling show delayed step onsets during backward reactive stepping. Specifically, for every 10-millisecond increase in step latency, PwMS were 2.5 times more likely to have a fall history. Although clinical trials are necessary to determine whether interventions targeting reactive stepping reduce falls in PwMS, the current work indicates that the latency of steps may be a relevant target for this work.

IMPACT

Subsequent fall prevention clinical trials should consider targeting backward reactive step latency to further assess its relevance for rehabilitation in PwMS.

LAY SUMMARY

If you have MS and a history of falls, you may be more likely to have delayed reactive step latencies.