The Fes-I Predicts Falls and ABC Scores In People With Multiple Sclerosis

Background: People with MS (PwMS) fear falling and fall frequently. The Falls Efficacy Scale-International (FES-I) was designed to assess concern about falling in the elderly.  The Activities-specific Balance Confidence (ABC) scale was designed to assess confidence in avoiding falls in the elderly. These two scales have also been used to measure fear of falling and perceived ability to avoid falls in people with MS (PwMS).  Scores on both scales are also related to fall risk in PwMS, but their ability to predict falls in this population has not been compared.

Objectives: To compare, in PwMS, how well the FES-I and the ABC scale predict who will fall in the following 6 months.

Methods: Subjects were 58 PwMS, aged 18-50 years, with Expanded Disability Status Scale scores ≤ 6.0 participating in a prospective study of mechanisms of imbalance in MS.  Subjects completed the FES-I, the ABC scale and six monthly prospective fall calendars. The t-test was used to compare mean scores on the FES-I and the ABC between those who fell and those who did not fall in the following 6 months.  Receiver Operating Characteristics (ROC) curves were generated to assess the accuracy of the FES-I and the ABC in predicting the presence or absence of falls in the following 6 months. The areas under the ROC curves were compared using chi-square test. Stata version 12 was used for all statistical analysis.

Results: 53 subjects completed the study and were included in the analysis. 37 subjects fell at least once in the 6-month period.  Mean FES-I and ABC scores were significantly different for those who did or did not fall in the following 6 months (FES-I: fallers 27.8 ± 10.2 versus non-fallers 21.4 ± 5.8; p=0.03.  ABC:  fallers 74.4 ± 21.7 versus non-fallers 87.9 ± 15.6; p=0.03).  Area under the curve (AUC) for the FES-I was 0.698 and for the ABC was 0.727.  These AUCs were not significantly different (p=0.39). 

Conclusions: The FES-I and the ABC scale have a similar ability to predict which PwMS will or will not fall in the following 6 months. Thus, to identify PwMS who are at risk for falling, the use of either scale as a screening tool is justified. Further research is required to investigate the multifactorial temporal relationship among concern for falling, confidence in avoiding falls, fear of falling, and actual fall events.