School of Health Professions, Plymouth University, UK.
Mult Scler. 2013 Dec;19(14):1913-22. doi: 10.1177/1352458513488233. Epub 2013 Apr 30.
People with multiple sclerosis (MS) experience frequent falls, which are associated with impairments and limitations to activities and participations.
The objective of this paper is to evaluate falls risk factors using robust clinical measures.
A total of 150 individuals (confirmed MS diagnosis, Expanded Disability Status Scale (EDSS) 3.5-6.5) were recruited, with 148 participants included in the final analysis. Demographic data were collected and performance assessed in eight predictor measures (Physiological Profile Assessment (PPA), Brief Ataxia Rating scale, Ashworth scale (Ashworth), Modified Falls Efficacy scale, Symbol Digit Modalities Test, dual-task interference, lying/standing blood pressure, static/dynamic visual acuity). Participants prospectively recorded falls over three months using a daily diary. People were classified as "fallers" based on reports of ≥ two falls.
A total of 104 participants recorded 672 falls; 78 (52.7%) reported ≥ two falls. Continence issues, previous falls history and use of prescribed medications were each associated with increased risk of being a "faller". Ashworth and PPA risk score contributed significantly to a logistic regression model predicting faller/non-faller classification. The reduced model (Ashworth, PPA, EDSS) showed fair-to-good predictive ability (ROC c-statistic 0.73, sensitivity 70%, specificity 69%).
This study confirms the high prevalence of falls in ambulant people with MS. Important potentially modifiable risk factors are identified, suggesting aspects to target in falls interventions.
多发性硬化症（MS）患者经常会摔倒，这与活动和参与受限有关。
本文旨在通过可靠的临床指标评估跌倒风险因素。
共招募了 150 名个体（确诊 MS 诊断，扩展残疾状况量表（EDSS）3.5-6.5），最终有 148 名参与者纳入了最终分析。收集了人口统计学数据，并对八项预测指标（生理概况评估（PPA）、简要共济失调评定量表、Ashworth 量表（Ashworth）、改良跌倒效能量表、符号数字模态测验、双重任务干扰、仰卧/站立血压、静态/动态视力）进行了评估。参与者前瞻性地使用每日日记记录了三个月内的跌倒情况。根据报告的≥2 次跌倒，将人们分为“跌倒者”。
共有 104 名参与者记录了 672 次跌倒；78 名（52.7%）报告了≥2 次跌倒。有大小便失禁问题、有跌倒史和使用规定药物的人，跌倒的风险增加。Ashworth 和 PPA 风险评分对预测跌倒者/非跌倒者分类的逻辑回归模型有显著贡献。简化模型（Ashworth、PPA、EDSS）显示出良好的预测能力（ROC c 统计量 0.73，敏感性 70%，特异性 69%）。
本研究证实了活动性 MS 患者中跌倒的高发生率。确定了一些重要的潜在可改变风险因素，提示可以针对跌倒干预措施的各个方面。
