Risk Factors of fall in Subjects with Multiple Sclerosis

Öz

Purpose: The purpose of the study was to estimate the number and type of falls and fall-related injuries in patients with Multiple Sclerosis (MS) and to identify risk factors for falls. Material and methods: Functional Independence Measure (FIM), Berg Balance Evaluation , Motricity index (MI), Ashworth Scale, Beck Depression Inventory (BDÖ) and Mini-Mental State Examination (MMDD) were used to assess 60 cases with MS. Results: Thirty-seven of the cases were grouped as “nonfallers”, twenty-three as “fallers”. These 2 groups were found to be different from each other in respect to FIM, Berg, BDÖ, Duration and MI (p<0.05-0.001). There is a difference between the groups in respect to Ashworth assessment (p<0.01). No statistical differences were found between groups of fallers and nonfallers using variables age, gender and MMDD (p>0.05). Falls occured in the daytime (74 %), indoors (66 %) and while walking (52 %). It was found that the most common type of injury in the falls was contusion (79 %). According to Ordinal logistic regression analysis, it was found that the possibility of fall increased (p<0.05), as the value of spasticity increased while the possibility of the fall of the individuals with MS decreased (p< 0.01) as Berg, MI and FIM variables increased. Conclusions: Among MS patients, falls are a complication especially affecting persons with motor dysfunction, balance abnormalities, functional impairment and spasticity. Key words: Multiple sclerosis, falls, rehabilitation

Anahtar Kelimeler

• -

Multipl Skleroz’lu Olgularda Düşmelerin Risk Faktörleri

Öz

Amaç: Çalışmanın amacı, Multiple Sclerosis (MS) olgularında düşmelerin dağılımını, oluştuğu şartları ve düşme ile ilişkili yaralanmaları belirlemek ve risk faktörlerini araştırmaktır. Gereç ve Yöntem: MS'li 60 olguyu değerlendirmek için, Fonksiyonel Bağımsızlık Ölçeği (FIM), Berg Denge Değerlendirmesi, Motricity index (MI), Ashworth skala, Beck Depresyon Ölçeği (BDÖ) ve Mini-Mental Durum Değerlendirmesi (MMDD) kullanılmıştır. Bulgular: Olguların, otuz-yedi'si düşmeyenler, yirmi-üç'ü düşenler olarak gruplandırılmıştır. Çalışmada oluşturulan iki düşme grubu, hastalık süresi, FIM, Berg, MI ve BDÖ yönünden birbirlerinden farklı bulunmuştur (p<0.05-0.001). Ashworth değerlendirmesi yönünden, gruplar arasında fark vardır (p<0.01). Yaş, cinsiyet ve MMDD yönünden gruplar arasında fark bulunmamıştır (p>0.05). Düşmeler en sık, gündüz (%74), ev içinde (%66) ve yürürken (%52) oluşmuştur. Düşmelerde en fazla görülen yaralanma tipi, kontüzyondur (%79). Ordinal lojistik regresyon analizi, Berg, MI ve FIM değişkenlerinin değerleri arttıkça MS'li kişilerin düşme olasılıklarının azaldığını (p<0.01), spastisite değeri arttıkça düşme olasılığının arttığını göstermiştir (p<0.05). Sonuç: MS hastaları arasında, düşmeler, özellikle motor, denge, fonksiyonel bozukluk ve spastisiteli olguları etkileyen bir komplikasyondur. Anahtar Kelimler: Multipl skleroz, düşmeler, rehabilitasyon

Anahtar Kelimeler

• Multipl skleroz, düşmeler, rehabilitasyon

Kaynakça

1. Ramnemark A, Nilsson M, Borssen B. A major and increasing risk factor for femoral neck fracture. Stroke 2000; 31: 1572-7.
2. Langhorne P, Stott DJ, Robertson L. Medical complications after stroke: a multicenter study. Stroke 2000; 31: 1223-9.
3. Roth EJ, Lovell L, Harvey RL. Incidence of and risk factors for medical complications during stroke rehabilitations. Stroke 2001; 32: 523-9.
4. Stolze H, Klebe S, Zechlin C. Falls in frequent neurological diseases. J Neurol 2004; 251: 79-84.
5. Syrjala P, Luukinen H, Pyhtinen J. Neurological diseases and accidental falls of the aged. J Neurol 2003; 250: 1063-9.
6. Masud T, Morris RO. Epidemiology of falls. Age Ageing 2001; 30: 3-7.
7. Cesari M, Landi F, Torre S. Prevalence and risk factors for falls in an older community-dwelling population. J Gerontol A Biol Sci Med Sci 2002; 57: M722-M6.
8. Bradley W, Daroff R, Fenichel G, Marsden C. Neurology in clinical practice. The neurological disorders.3 rd ed. Marsden DC. Boston:Butterwotth-Heinemann, 2000, 1431-63.

9. Cattoneo D, Carmela De N, Fascia T, Macalli M. Risk of falls in subjects with multiple sclerosis. Arch Phys Med Rehabil 2002; 83:864-7.
10. Poser CM, Paty DW, Scheinberg LC, et al. New diagnostic criteria for multiple sclerosis: quidelines for research protocols. Ann Neurol 1983; 13: 227- 31.
11. Mc Donald WI, Compston A, Edan G, et al. Recommended diagnostic criteria for multiple sclerosis: quidelines from the international panel on the dignosis of multiple sclerosis. Ann Neurol 2001; 50: 121-7.
12. Kurtzke JF. Rating neurologic impairment in multiple sclerosis: an expanded disability status scale (EDSS). Neurology 1983; 33: 1444- 52.
13. Wade DT. Measurement in neurological rehabilitation. Oxford: Oxford Univ Pr; 1995.
14. Ashworth B. Preliminary trial of carisoprodol in multiple sclerosis. Practitioner 1964; 192: 540- 42.
15. Rankin A. Functional independence measue. Physiotherapy 1993;79:842-3.
16. Beck AT, Ward CH, Mendelson M, Mock JE. An inventory for measuring depression. Archives of General Psychiatry 1961;4:561-71.
17. Berg K, Wood-Dauphinee S, Williams JI. Measuring balance in the elderly:preliminary development of an instrument. Physiother Can 1989;41:304.
18. Pfeiffer E. A short portable mental status questionnaire for the assessment of organic brain deficit in elderly patients. J Am Geriatr Soc 1975;23:433-41.
19. Hyndman D, Ashburn A, Stack E. Fall events among people with stroke living in the community: circumstances of falls and characteristics of fallers. Arch Phys Med Rehabil 2002; 83: 165-70.
20. Watkins CL, Leathley MJ, Gregson JM, Moore AP, Smith TL. Prevalence of spasticity post stroke. Clin Rehabil 2002; 16:515-22.
21. Disa K, Elsy UB, Svensson AK, Holmqvist LW. Spasticity after stroke. Stroke 2004;35:134-44.
22. Thompson AJ, Jarrett L, Lockley L. Clinical management of spasticity. J Neurol Neurosurg Psychiatry 2005; 76:459-63.
23. Thorbahn LD, Newton RA. Use of the Berg balance test to predict falls in elderly persons. Phys Ther 1996; 76:576-83.