Identifying fall risks in MS

Professor Stephen Lord

Neuroscience Research Australia, NSW

| Better treatments | Social And Applied Research | Project | 2012 | Investigator Led Research |
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Summary

Research shows that up to 60% of people with MS will have experienced a fall in the previous six months, and a large proportion of these falls result in an injury requiring medical attention. Preventing falls and increasing the confidence of people with MS to move about without the fear of falling is, therefore, of primary importance in maintaining health and quality of life in people living with MS.

Many of the symptoms typical of MS, such as poor balance, muscle weakness, visual impairments, altered sensation and impaired thinking can contribute to the risk of falling. But the key to preventing falls is increasing our understanding of which combinations of symptoms pose the greatest risk.

Professor Lord is a leading international researcher in the field of applied physiology and falls in older people. He has previously designed a Physiological Profile Assessment tool for identifying the profile of falls risk factors in individuals. Known as FallScreen®, the tool is now used by researchers and clinicians around the world.

Professor Lord will work with prominent neurologist, Professor Gandevia, and Dr Phu Hoang, a NeuRA researcher and senior physiotherapist at MSA - ACT/NSW/VIC. The team will combine FallScreen® with additional tests of balance, psychological, health and lifestyle factors, to determine the profile of symptoms in people with MS.

A pilot study has confirmed that the tests are feasible for people with MS to complete without causing fatigue and has already generated some valuable insights. Over the next two years the team will expand the study to a total of 300 people with MS.

The end result will be a clinical assessment tool, specific for MS, to help predict falls. It will lay a solid foundation from which exercise and other prevention programs can be designed for safe, appropriate and effective falls prevention.

Project Outcomes

To date the team has assessed 210 community-dwelling people with MS and completed the 6-month follow-up for falls. In the follow-up period, 83 participants (39.7%) experienced no falls, 57 (27.3%) fell once or twice and 69 (33.0%) fell three or more times. The analysis has revealed important balance, coordination and cognitive determinants of falls in MS, and particularly found that poor balance and upper limb fine motor control were most predictive for the risk of falling. Frequent falling (3 times or more) was associated with poor performance in balance tests with either eyes open and closed, slow reaction in stepping time, reduced walking speed, executive functioning and fine motor control. Poor performance in balance and upper limb fine motor control tests were identified as variables that significantly and independently discriminated between frequent fallers and non-frequent fallers. This information will assist the development of effective strategies for prevention of falls in this high-risk group. Further analyses are underway to determine other risk factors related to falls for people with MS.

The team are working on an international collaborative project which aims to combine falls data from different countries (Australia, England, USA, Canada and Sweden) to provide a comprehensive picture of physiological and psychological factors related to falls for people with MS. These outcomes have resulted in two manuscripts that have currently been submitted for publication, and were  presented at the 29th ECTRIMS conference at Copenhagen, Denmark in October 2013.

This work has resulted in two papers already published in a scientific journal, and another two underway (see below for details).

In addition, a pilot randomised trial has begun that aims to look at the benefits of step training exercises for reducing the risk of falls in 50 people with MS. This trial is ongoing and will be completed during 2014, with aims including undertaking the exercise group participant support, retest assessments and follow-up surveillance, as well as analysis and manuscript preparation.

Publications

  • Rob van Vliet, Phu Hoang, Stephen Lord, Simon Gandevia, Kim Delbaere. The Falls Efficacy Scale- International: A cross-sectional validation in people with multiple sclerosis. Arch Phys Med Rehabil, 2012 94(5), 883-889. doi: 10.1016/j.apmr.2012.10.034.
  • Phu Hoang, Michelle Cameron, Simon Gandevia, and Stephen Lord. Neuropsychological, balance and mobility risk factors for falls in people with multiple sclerosis: a prospective cohort study. Arch Phys Med Rehabil 2013. 95(3), 480-486. doi: 10.1016/j.apmr.2013.09.017
  • Nilsagård Y, Gunn H, Freeman J, Hoang P, Lord S, Mazumder R, Cameron M. Falls in people with MS-an individual data meta-analysis from studies from Australia,Sweden, United Kingdom and the United States. Mult Scler. 2014 Jun 16. pii:1352458514538884. [Epub ahead of print] PubMed PMID: 24948687.
  • van Vliet R, Hoang P, Lord S, Gandevia S, Delbaere K. Multiple sclerosis severity and concern about falling: Physical, cognitive and psychological mediating factors. NeuroRehabilitation. 2015 Aug 22;37(1):139-47. doi:10.3233/NRE-151246. PubMed PMID: 26409699.

Updated: 30 June 2014

Updated: 06 January, 2012

Investigator

Grant Awarded

  •  Project Grant

Total Funding

  • $110,000

Duration

  • 2 years over 2012 - 2013

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Identifying fall risks in MS