Giannì Costanza, Prosperini Luca, Jonsdottir Johanna, Cattaneo Davide
Department of Neurology and Psychiatry, Sapienza University, Rome, Italy.
Department of Neurology and Psychiatry, Sapienza University, Rome, Italy
Clin Rehabil. 2014 Jul;28(7):704-16. doi: 10.1177/0269215513517575. Epub 2014 Feb 25.
To determine whether there are demographic, clinical, and instrumental variables useful to detect fall status of patients with multiple sclerosis.
PubMed and the Cochrane Library.
Eligible studies were identified by two independent investigators. Only studies having a clear distinction between fallers and non-fallers were included and meta-analysed. Odds ratios (ORs) and standard mean differences (SMDs) were calculated and pooled using fixed effect models.
Among 115 screened articles, 15 fulfilled criteria for meta-analyses, with a total of 2425 patients included. Proportion of fallers may vary from 30% to 63% in a time frame from 1 to 12 months. No significant publication bias was found, even though 12/15 studies relied on retrospective reports of falls, thus introducing recall biases. Risk factors for falls varied across studies, owing to heterogeneity of populations included and clinical instruments used. The meta-analytic approach found that, compared with non-fallers, fallers had longer disease duration (SMD = 0.14, p = 0.02), progressive course of disease (OR = 2.02, p < 0.0001), assistive device for walking (OR = 3.16, p < 0.0001), greater overall disability level (SMD = 0.74, p < 0.0001), slower walking speed (SMD = 0.45, p = 0.0005), and worse performances in balance tests (Berg Balance Scale: SMD = -0.48, p = 0.002; Timed up-and-go test, SMD = 0.31, p = 0.04), and force-platform measures (postural sway) with eyes opened (SMD = 0.71, p = 0.006) and closed (SMD = 0.83, p = 0.01), respectively.
Elucidations regarding risk factors for accidental falls in patients with multiple sclerosis (PwMs) are provided here, with worse disability score, progressive course, use of walking aid, and poorer performances in static and dynamic balance tests strongly associated with fall status.
确定是否存在有助于检测多发性硬化症患者跌倒状态的人口统计学、临床和仪器变量。
PubMed和Cochrane图书馆。
由两名独立研究人员确定符合条件的研究。仅纳入并荟萃分析了在跌倒者和未跌倒者之间有明确区分的研究。使用固定效应模型计算并汇总比值比（OR）和标准均数差（SMD）。
在115篇筛选的文章中，15篇符合荟萃分析标准，共纳入2425例患者。在1至12个月的时间范围内，跌倒者的比例可能在30%至63%之间变化。尽管15项研究中有12项依赖于跌倒的回顾性报告，从而引入了回忆偏倚，但未发现明显的发表偏倚。由于纳入人群和使用的临床仪器的异质性，不同研究中跌倒的危险因素各不相同。荟萃分析方法发现，与未跌倒者相比，跌倒者的疾病持续时间更长（SMD = 0.14，p = 0.02）、疾病呈进展性病程（OR = 2.02，p < 0.0001）、使用助行器（OR = 3.16，p < 0.0001）、总体残疾水平更高（SMD = 0.74，p < 0.0001）、步行速度较慢（SMD = 0.45，p = 0.0005），并且在平衡测试中的表现更差（伯格平衡量表：SMD = -0.48，p = 0.002；计时起立行走测试，SMD = 0.31，p = 0.04），以及在睁眼（SMD = 0.71，p = 0.006）和闭眼（SMD = 0.83，p = 0.01）时的力平台测量（姿势摆动）。
本文提供了关于多发性硬化症患者意外跌倒危险因素的阐释，残疾评分更差、疾病呈进展性病程、使用助行器以及在静态和动态平衡测试中的表现更差与跌倒状态密切相关。
