Abstract: Circumstances Surrounding Falls in Individuals With Multiple Sclerosis (The 27th Annual Meeting of the CMSC and the 5th Cooperative Meeting of the CMSC-ACTRIMS)

Saturday, June 1, 2013

Moira Baynes, RN , Neurology, Johns Hopkins University, Baltimore, MD

Scott D Newsome, D.O. , Neurology, Johns Hopkins School of Medicine, Baltimore, MD

Dorlan Kimbrough, MD , Neurology, Johns Hopkins University, Baltimore, MD

Peter A Calabresi, MD, FAAN , Neurology, Johns Hopkins University, Baltimore, MD

Kathleen M Zackowski, PhD, OT , Physical Medicine and Rehabilitation, Johns Hopkins School of Medicine, Baltimore, MD

Background: Fall rates among adults with multiple sclerosis (MS) are consistently greater than 50%. Fall risk factors are known to be diverse, yet interventions to improve this remain unclear in MS. It is possible that health care providers may be more broadly effective in decreasing individuals fall risks, if the circumstances surrounding these falls were better understood.

Objectives: To identify, in a cohort of individuals with MS, the number of falls per month and circumstances that are present when they fall. We hypothesize that individuals who fall may do so under particular circumstances, and that these circumstances may be modifiable.

Methods: Fifty-six MS subjects (with relapsing and progressive MS) from the Hopkins MS Center were surveyed about their fall rate and circumstances surrounding a fall or near fall. The survey had 5 sections that asked about: (1) the frequency and severity of falls based on the 4-point Hopkins Falls Grading Scale (Fall Grades: 1-near fall; 2-no medical assistance; 3-with medical assistance; 4-hospital admission); Section (2) use of assistive devices; (3) the time of day of falls; (4) circumstances surrounding falls; (5) asked if anyone was with the person when they fell. We also tested Timed Up and Go, and Timed 25 Foot Walk. Correlation matrices identified 4 variables (i.e., survey questions and timed tests) that were highly correlated with monthly fall rate, these were used in regression analyses.

Results: 36% of the cohort reports using an assistive device, 80% of those using a device report falling at least once a month. The data show 4 conditions that are most highly correlated with monthly fall rates: moving from bed to chair, moving over a slippery surface, experiencing vertigo, and visual changes; all other variables were much less correlated. Regression analyses show that 4 conditions explain 50% of the variance in monthly fall rates (p<0.001). A stepwise regression model shows that “moving from bed to chair” is significantly related to monthly fall rate (p<0.01).

Conclusions: These data show that there are specific circumstances that commonly surround falls in MS. This suggests that providing additional training to individuals about transfers, walking over slippery surfaces, as well as how to accommodate for acute visual changes and vertigo may be influential in decreasing the risk of falls in people with MS. This study is a first step in understanding the circumstances surrounding falls.

P50 Circumstances Surrounding Falls in Individuals With Multiple Sclerosis