Associations Between Physiological and Perceived Fall Risk in Multiple Sclerosis

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Investigators note that tailored behavioral and physical interventions may be beneficial for the patient's individual need.

Patients with multiple sclerosis have a disparity between their physiological risk of falling and their perceived risk of falling, both of which correspond to the risk for recurrent falls, according to a study published in Archives of Physical Medicine and Rehabilitation.

The study included 416 participants with multiple sclerosis of all subtypes. Physiological fall risk was assessed and scored using the Physiological Profile Assessment (PPA), and the perceived fall risk was assessed and scored using the Falls Efficacy Scale-international questionnaire (FESi). Retrospective assessments of fall incidence were done via interview, although prospective assessments were done using standardized daily diary sheets for recording falls.

Data analyses found that higher FESi and PPA scores increased the odds of participants being recurrent fallers [FESi odds ratio [OR] 1.05 (95% confidence interval [CI] 1.03-1.07), PPA OR 1.30 (95% CI 1.17-1.46)], with PPA being the superior predictor. In the low physiological and high perceived risk group, 37% of participants (n=63) were identified as recurrent fallers. Some of these participants may have had additional physical risk factors such as spasticity, impaired gait, and dual task interference, which are not included in the PPA, making their scores less predictive of falls.

More than half of the high physiological and low perceived risk group (10% of total participants) reported no falls, which may suggest that their perceptions were accurate or that they have learned effective strategies for avoiding falls. Some falls were reported by the group with low physiological and low perceived risk of falling, suggesting that early intervention emphasizing preventative strategies could be needed to minimize the long-term negative effects of falls in this group.

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Study investigators conclude, “Whilst both the PPA and the FESi independently predicted falls in this cohort, the subsequent classification and regression tree analysis highlighted an interrelationship between the two factors which could have important implications for management. These findings are consistent with the geriatrics literature and its growing focus on targeted, individualized fall prevention, addressing both factors. These findings also underline the complexity of falls in [multiple sclerosis] and the importance of detailed description, evaluation and targeting of fall prevention interventions to optimize their effectiveness.”


Gunn H, Cameron M, Hoang P, Lord S, Shaw S, Freeman J. The relationship between physiological and perceived fall risk in people with multiple sclerosis: implications for assessment and management [published online April 23, 2018]. Arch Phys Med Rehabil. doi: 10.1016/j.apmr.2018.03.019