Falls Status Is Associated With Greater Impact Of MS and Fatigue

Background: Falls are a significant problem for people with MS with a prevalence of 50%.  Previous work has demonstrated that fall prevalence is influenced by mobility status.  Consequently, it is possible that fallers may have a different clinical profile compared to non-fallers as a function of mobility status.

Objectives:  To investigate whether fallers have a different profile compared to non-fallers on a range of clinical variables, and to investigate whether mobility status moderates that relationship. 

Methods: Self-reported falls were extracted from the baseline data of a RCT along with the Six Minute Walk Test (6MWT) distance, Modified Fatigue Impact Scale (MFIS) score and physical and psychological scores on the Multiple Sclerosis Impact Scale 29v2 (MSIS). A faller was defined by having one or more falls in the three months prior to assessment. Mobility status was rated using 5 categories of the mobility section of the Guys Neurological Disability Rating Scale (GNDS). A two way between groups ANOVA was conducted to explore the impact of falls and mobility status on those measures.

Results: There were 365 people in the sample, of whom 124 had fallen in the last three months, giving a falls prevalence of 33.97%. Mean age was 51.6 (10.9) years and mean time since diagnosis of 12.4 (8.5) years. There was no significant interaction effect between falls status and mobility status for any of the variables. There was a significant main effect for fall status (DofF=1) on the MSIS-29physical (f, 7.58 p=0.006)   MSIS psychological (f, 7.62 p=0.006) and MFIS (f, 6.46 p=0.01). There was a significant main effect for mobility status (DofF 4) on the MSIS physical (f, 31.27, p<0.001), and 6MWT distance (f, 89.14 p<0.001). The MSIS physical score for those reporting no mobility problems or mild problems with no aid were significantly different to those who used single and bilateral support. The 6MWT distance scores between all mobility status categories were significantly different with the exception that those using bilateral support or bilateral support with occasional wheelchair use did not differ.

Conclusions: Overall fallers had worse MSIS-29 physical, MSIS psychological, and MFIS scores compared to non-fallers.  Additionally, persons with greater mobility limitations had worse MSIS physical and 6MWT scores.  There was no interaction between fall status and mobility status on those measures. This may be due to the small numbers or lack of sensitivity in the measures used. Further research examining the impact of falls and mobility status on other clinical variables is required.