A Systematic Review of the Relationship Between the Use of Walking Assistive Devices and Falls in People with Multiple Sclerosis

Background: Falls are a common occurrence in people with multiple sclerosis (MS), and often result in injury or hospitalization which may cause further declines in balance and walking ability and self-efficacy. Many people with MS opt to use assistive devices (AD) for walking (e.g. walkers/walking frames, canes/walking sticks) in response to previous or near falls, or due to a decrease in balance and walking confidence and self-efficacy. It seems intuitive that the use of walking AD would ameliorate walking dysfunction and improve self-efficacy related to walking and balance; however, this relationship is unclear.

Objectives: This narrative systematic review was conducted to describe the relationship between falls and walking AD use in people with MS.

Methods: The PubMed, CINAHL and Scopus databases were searched using the combined terms “multiple sclerosis” “Assistive Device” and “Falls” or “Gait”. Inclusion criteria were research studies that measured gait and walking, assistive device use, and falls in a sample of people with MS. Nine articles met the criteria. Each article was reviewed by two members of the team, and relevant information was extracted for the review.

Results: People with MS who used ADs had a higher incidence and risk of falls than those who did not. This was found consistently in both prospective and retrospective studies. AD use played a contributory but varied role in regression models that predicted falls risk. AD users had lower scores on measures of balance confidence/self-efficacy than non-AD users. AD users also had more variability in temporal-spatial gait parameters during straight path walking than those who did not use ADs.

Conclusions: There is a clear relationship between AD use and increased falls risk, and between AD use and poorer balance/walking efficacy in people with MS. Although the correlation is clear, causality between these variables is not. Though it seems intuitive that ADs would be used by people with MS who have poor balance and/or walking ability and self-efficacy, it is not clear whether AD use in fact improves physical function and self-efficacy. Additional research should be conducted to examine whether there is a causal relationship between AD use and elevated falls risk and diminished self-efficacy to help guide decisions whether to recommend the use of walking ADs by people with MS.