Research Investigates Dangers of Falling in People with Multiple Sclerosis

For people with multiple sclerosis who use wheelchairs or scooters to be mobile, falls are a considerably large concern. Recently, a study was conducted in order to analyze the circumstances surrounding such falls, and how common they are.

Background

Because multiple sclerosis can involve focal inflammation throughout the central nervous system, conduction delays and blockage of action potentials on nerve axons can result. Because of this, cognitive impairment, muscle weakness, sensory disturbances, among many other impairments can be common. Due to these weaknesses, falls become common and about half of ambulatory people with multiple sclerosis have said that they fall at least once every six months. Sometimes, these falls can result in serious injuries, which is why hip fractures are four times more likely in people with multiple sclerosis compared to those without.

When someone with MS has taken a fall, their physical and psychological health status becomes markedly lower. One major side effect of falls, or even near falls, is a fear of falling that can hinder daily activities and quality of life.

However, there is hope. Because of the dangers of falling, many researchers have been focusing on modifying risk factors for falling and how to create targeted rehabilitation interventions. Unfortunately, most of this research is nearly entirely focused on those who are ambulatory, such as the "Free from Falls" program or the International MS Falls Prevention research network. Why leave out those who use scooters or wheelchairs as their primary mode of mobility? Most likely because there is very little information available, which is why researchers set out to gain further data about the prevalence and circumstances of falls for those who use wheelchairs and scooters to get around.

Specifics of the study

Forty-four people with MS were enlisted from the Shepherd Center in Atlanta, Georgia, the Sheba MS Center in Tel-Hashomer, Israel, and the University of Illinois at Urbana-Champaign in Illinois, each of which approved of the study, between May 2014 and July 2015. The participants had a mean age of 58-years old, 74% were female, and relapsing/remitting and progressive/relapsing MS were the highest reported types of MS within the group of participants. The criteria for being a part of the study was having the ability to understand English or Hebrew, be over the age of 18, have a diagnosis of MS, use a wheelchair or scooter for primary means of mobility, possess an inability to ambulate community distances, and be able to participate in transfers. The approved participants had their neurological disabilities measured, and their results were between 7.0 and 7.5 on the Kurtzke Expanded Disability Status scale.

Once the participants had been finalized, they were requested to complete a survey that was available physically or online that would take approximately half an hour to complete. After reviewing the informed consent and agreeing to the purpose and risks associated with the study, the participants were allowed to begin.

The survey

Participants were asked about their basic demographics via the survey, but also many questions about how the disease impacts them personally. They were asked about what type of mobility device they use, and how often they need to use it. They were also asked very specific questions surrounding the topic of falls such as how often they have fallen in approximately six months, the location of their falls, and if the falls resulted in injuries and if so, how severe. They were then asked about their anxiety towards falling and how often they think about falling, and how this impacts their decisions to partake in certain activities. 

Participants were also requested to complete the Fatigue Severity Scale, Multiple Sclerosis Impact Scale, Spinal Cord Injury-Fall Concerns Scale, Multiple Sclerosis Neurophysiological Screening Questionnaire, and World Health Organization Quality of Life questionnaire.

In the study, a fall was defined as "unintentionally coming to rest on the ground, floor, or other lower level, excluding intentional changes in position to rest on furniture, walls, or other objects."

Results

From the data acquired from the surveys, the researchers used SPSS to analyze the frequency of falls in conjunction to their characteristics and circumstances. Of course, because the study was a survey, not all possible data was available. The results and percentages were based on the number of responses to each question.

The results of the survey showed that approximately 75% of the participants reported falling within six months. Out of those who had reported falling, an average of 12.3 falls happened in that period of six months. Most of the falls (87.5%) were said to have taken place within their home as opposed to the 9.4% that was reported to have taken place outside.

A major part of the study was to try to understand the circumstances surrounding the falls, and not just the frequency. The top reported activities during falls discussed by the participants were using the toilet (19.4%), transferring (13.9%), walking short distances (13.9%) and reaching for objects (13.9%).

Regardless of the frequency or type of fall, gaining insight into the injuries that occurred from the falls was important. 48% of the participants stated that they had gotten an injury due to the fall and 33.3% of the participants claimed they had gone to their healthcare professional to discuss the injury that they were suffering with.

76.7% of the participants said that they have a serious concern about falling and 65.9% of participants stated that they are weary of performing certain tasks and avoid certain activities due to the potential of falling.

To find out how this correlated to what type of device was used, the researchers found that the majority of the participants used a manual wheelchair, for approximately 30 hours per week.

66.7% of power wheelchair users stated that they had fallen when using a power wheelchair, 37.5% of manual wheelchair users fell when with a manual wheelchair, and 66.7% who utilize scooters reported falling when using a scooter. The two highest percentages of falls came from walker and cane users, who reported that 71.4% who use a walker had fallen while using it and 100% of cane users had fallen while being assisted by a cane.

Conclusions

Because such a high percentage of people fall while using these devices, the researchers urge that clinicians prepare patients on how to properly use their mobility devices to avoid falls and injuries. Unfortunately, much of the current research about falls in correlation with MS mainly focuses on people who use walking as their primary mode of mobility, and not those who require wheelchairs, scooters, etc. With studies like these, the amount of good can be done for those who are on the margins of research can skyrocket. This shows the importance of involving all people within a group in research, and not generalizing people with MS to those who are able to walk on their own. The researchers concluded by explaining, "as a result of the high frequency of falls and significant consequences, further research to manage fall frequency is essential and must be a priority among researchers." Hopefully the work done by these researchers will be continued by others to enable further breakthroughs for those with MS.
Reference

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5585490/