How Right Are Multiple Sclerosis Patients in Fear of Falling? A Comparative Study

Year 2022, , 236 - 247, 30.04.2022

Fatih Tekin , Furkan Bilek

https://doi.org/10.21020/husbfd.1001761

Abstract

Objectives: The aim of this study was to investigate the factors underlying the fear of falling in Multiple Sclerosis (MS) patients and to determine the share of physical and psychological components in this fear.
Materials and Methods: Patients between the ages of 18-65 years, diagnosed with Relapsing-Remitting form of MS were included in the study. Timed Up and Go Test (TUG) was used to assess gait functions and balance skills of patients during gait, Berg Balance Test (BBT) to assess balance skills in general, Fall Efficacy Scale-International (FES-I) to assess fear of falling, and Expanded Disability Status Scale (EDSS) to assess MS severity of the patients.
Results: Forty-four patients (F:32 M:12) diagnosed with MS, with a mean age of 37.23±9.67 years, were included in our study. There was a statistically significant, positive and moderate correlation between the fear of falling and the number of attacks in the last 1 year (r=0.433, p=0.039), a statistically significant, positive and high-level correlation between fear of falling and falling history in the last 1 year (r=0.912, p=0.001), disability status (r=0.940, p=0.001) and TUG test (r=0.901, p=0.001) and a significant, negative and high-level correlation between fear of falling and balance skills (r=-0.944, p=0.001). According to the regression analysis, while the effects of falling history (p=0.043), BBT (p=0.025), TUG (p=0.004), and EDSS (p=0.007) on FES-1 were significant, the effect of TPLA was insignificant (p>0.05).
Conclusion: Patients with MS are right about their fear of falling in parallel with their disability and balance-gait skills. However, this relationship is bidirectional, and the fear of falling has the potential to increase these limitations even more in MS patients whose functional activities are already restricted or going to be restricted.

Keywords

balance, fear of falling, gait, multiple sclerosis

Thanks

As the authors, we would like to thank Prof. Dr. Caner Feyzi DEMİR for his important contributions to our study.

References

• Ascherio, A. (2013). Environmental factors in multiple sclerosis. Expert Review of Neurotherapeutics, 13(sup2), 3-9. doi: 10.1586/14737175.2013.865866
• Berg, K., Wood-Dauphinee, S., & Williams, J. I. (1995). The Balance Scale: reliability assessment with elderly residents and patients with an acute stroke. Scandinavian Journal of Rehabilitation Medicine, 27(1), 27-36.
• Bernhard, F. P., Sartor, J., Bettecken, K., Hobert, M. A., Arnold, C., Weber, Y. G., et al. (2018). Wearables for gait and balance assessment in the neurological ward-study design and first results of a prospective cross-sectional feasibility study with 384 inpatients. BMC Neurology, 18(1), 1-8. doi: 10.1186/s12883-018-1111-7
• Browne, P., Chandraratna, D., Angood, C., Tremlett, H., Baker, C., Taylor, B. V., & Thompson, A. J. (2014). Atlas of multiple sclerosis 2013: a growing global problem with widespread inequity. Neurology, 83(11), 1022-1024. doi: 10.1212/WNL.0000000000000768
• Cameron, M. H., & Nilsagard, Y. (2018). Balance, gait, and falls in multiple sclerosis. Handbook of Clinical Neurology, 159, 237-250. doi: 10.1016/B978-0-444-63916-5.00015-X
• Comber, L., Galvin, R., & Coote, S. (2017). Gait deficits in people with multiple sclerosis: A systematic review and meta-analysis. Gait & Posture, 51, 25-35. doi: 10.1016/j.gaitpost.2016.09.026
• Delbaere, K., Close, J. C., Mikolaizak, A. S., Sachdev, P. S., Brodaty, H., & Lord, S. R. (2010). The falls efficacy scale international (FES-I). A comprehensive longitudinal validation study. Age and Ageing, 39(2), 210-216. doi: 10.1093/ageing/afp225
• Hafler, D. A. (2004). More MS news articles for April 2004. Journal of Clinical Investigation, 113, 788-794.
• Hershkovitz, L., Malcay, O., Grinberg, Y., Berkowitz, S., & Kalron, A. (2019). The contribution of the instrumented Timed-Up-and-Go test to detect falls and fear of falling in people with multiple sclerosis. Multiple Sclerosis and Related Disorders, 27, 226-231. doi: 10.1016/j.msard.2018.10.111
• Kalron, A., & Achiron, A. (2013). Postural control, falls and fear of falling in people with multiple sclerosis without mobility aids. Journal of the Neurological Sciences, 335(1-2), 186-190. doi: 10.1016/j.jns.2013.09.029
• Kalron, A., & Allali, G. (2017). Gait and cognitive impairments in multiple sclerosis: the specific contribution of falls and fear of falling. Journal of Neural Transmission, 124(11), 1407-1416. doi: 10.1007/s00702-017-1765-0
• Kalron, A., Aloni, R., Givon, U., & Menascu, S. (2018). Fear of falling, not falls, impacts leisure-time physical activity in people with multiple sclerosis. Gait & Posture, 65, 33-38. doi: 10.1016/j.gaitpost.2018.06.174
• Khalil, H., Al-Shorman, A., El-Salem, K., Abdo, N., Alghwiri, A. A., Aburub, A., et al. (2017). Fear of falling in people with multiple sclerosis: which clinical characteristics are important? Physical Therapy, 97(7), 698-706. doi: 10.1093/ptj/pzx044
• Kobelt, G., Thompson, A., Berg, J., Gannedahl, M., Eriksson, J., MSCOI Study Group, & European Multiple Sclerosis Platform. (2017). New insights into the burden and costs of multiple sclerosis in Europe. Multiple Sclerosis Journal, 23(8), 1123-1136. doi: 10.1177/1352458517694432
• Korkmaz, N. Ç., Duray, M., Hüzmeli, E. D., & Şenol, H. (2019). The Turkish version of the Modified Falls Efficacy Scale: reliability and validity from the viewpoint of balance. Turkish Journal of Medical Sciences, 49(6), 1727-1735. doi: 10.3906/sag-1903-212
• Kurtzke, J. F. (1983). Rating neurologic impairment in multiple sclerosis: an expanded disability status scale (EDSS). Neurology, 33(11), 1444-1444. doi: 10.1212/WNL.33.11.1444
• Lucchinetti, C., Brück, W., Parisi, J., Scheithauer, B., Rodriguez, M., & Lassmann, H. (2000). Heterogeneity of multiple sclerosis lesions: implications for the pathogenesis of demyelination. Annals of Neurology: Official Journal of the American Neurological Association and the Child Neurology Society, 47(6), 707-717. doi: 10.1002/1531-8249(200006)47:6<707::AID-ANA3>3.0.CO;2-Q
• Martin, R., McFarland, H. F., & McFarlin, D. E. (1992). Immunological aspects of demyelinating diseases. Annual Review of Immunology, 10(1), 153-187. doi: 10.1146/annurev.iy.10.040192.001101
• Matsuda, P. N., Shumway-Cook, A., Ciol, M. A., Bombardier, C. H., & Kartin, D. A. (2012). Understanding falls in multiple sclerosis: association of mobility status, concerns about falling, and accumulated impairments. Physical Therapy, 92(3), 407-415. doi: 10.2522/ptj.20100380
• Mazumder, R., Lambert, W. E., Nguyen, T., Bourdette, D. N., & Cameron, M. H. (2015). Fear of falling is associated with recurrent falls in people with multiple sclerosis: a longitudinal cohort study. International Journal of MS Care, 17(4), 164-170. doi: 10.7224/1537-2073.2014-042
• McFarland H. F. (1999). Correlation between MR and clinical findings of disease activity in multiple sclerosis. American Journal of Neuroradiology, 20(10), 1777–1778.
• Özakbaş, S. (2008). Multiple sklerozda özürlülüğün değerlendirilmesi. Nöropisikiyatri Arşivi, 45, 6-9.
• Peterson, E. W., Cho, C. C., & Finlayson, M. L. (2007). Fear of falling and associated activity curtailment among middle aged and older adults with multiple sclerosis. Multiple Sclerosis Journal, 13(9), 1168-1175. doi: 10.1177/1352458507079260
• Podsiadlo, D., & Richardson, S. (1991). The timed “Up & Go”: a test of basic functional mobility for frail elderly persons. Journal of the American Geriatrics Society, 39(2), 142-148. doi: 10.1111/j.1532-5415.1991.tb01616.x
• Raine, C. S., & Scheinberg, L. C. (1988). On the immunopathology of plaque development and repair in multiple sclerosis. Journal of Neuroimmunology, 20(2-3), 189-201. doi: 10.1016/0165-5728(88)90160-9
• Sahin, F., Yilmaz, F., Ozmaden, A., Kotevoglu, N., Sahin, T., & Kuran, B. (2008). Reliability and validity of the Turkish version of the Berg Balance Scale. Journal of Geriatric Physical Therapy, 31(1), 32-37.
• Scholz, M., Haase, R., Trentzsch, K., Weidemann, M. L., & Ziemssen, T. (2021). Fear of Falling and Falls in People with Multiple Sclerosis: A Literature Review. Multiple Sclerosis and Related Disorders, 47, 102609. doi: 10.1016/j.msard.2020.102609
• Yardley, L., Beyer, N., Hauer, K., Kempen, G., Piot-Ziegler, C., & Todd, C. (2005). Development and initial validation of the Falls Efficacy Scale-International (FES-I). Age and Ageing, 34(6), 614-619. doi: 10.1093/ageing/afi196