University of Virginia, 1221 Lee Street, Charlottesville, VA 22908, USA.
Oregon Health & Science University, VA Portland Health Care System, 3710 SW US Veterans Hospital Road, Portland, OR 97239, USA.
Mult Scler Relat Disord. 2019 Jun;31:151-156. doi: 10.1016/j.msard.2019.04.015. Epub 2019 Apr 13.
Falls are common and impactful in people with multiple sclerosis (MS) but currently there is no accepted standard of care for fall prevention in MS. Evidence supports that the in-person, group-based, Free from Falls (FFF) program is associated with both immediate and six-month sustained improvements in mobility and balance and a reduction in falls, but program attendance is limited by access to the class at a given time and location and by the cost and availability of trained facilitators. Therefore, we developed and evaluated an online, web-based version of FFF, Free from Falls Online (FFFO).
Thirty people with MS who reported falling at least twice in the previous two months were randomized to FFFO or to a control group. FFFO consists of eight weekly sessions, each with an instructional and exercise component. Subjects in the control group were given a brochure on minimizing fall risk, a letter was sent to their treating physician informing them that the subject reported falling, and these subjects were invited to use the FFFO program at study completion. Outcomes included baseline demographics, falls prospectively reported for the eight weeks of intervention and the following three months, and a program satisfaction survey for the active group. Regression models were used to test for associations between treatment group and fall incidence.
Subjects' mean age was 55.8 years, 70% were female, 73% had progressive MS, median Expanded Disability Status Scale (EDSS) score was 6.0, and subjects reported a median of two falls in the month prior to study enrollment. Although, in general, regression models demonstrated trends that those in the intervention group were less likely to fall than those in the control group, statistical significance was only achieved (p = 0.0038) with a post hoc model evaluating the relationship between the square of days and the probability of not falling. This model supported that those in the intervention group were slightly less likely to fall than those in the control group. This difference was most prominent in the first month of the study, less prominent in the following month, and not sustained three months following the intervention. User experience with FFFO was overall positive, with over 75% reporting the web-based program easy to learn and to use, 85% reporting the program was easy to follow, 62% reporting the material to be useful, and 77% finding the exercises to be a useful component of the program.
This study supports the viability of online delivery of self-management strategies in MS, suggests that FFFO may help prevent falls in people with MS, and provides the preliminary data needed to verify the findings of this pilot study of FFFO with a fully powered randomized controlled trial in people with MS.
多发性硬化症（MS）患者经常跌倒，且影响较大，但目前针对 MS 患者的跌倒预防尚无公认的标准治疗方法。有证据表明，面对面、小组制的“远离跌倒（FFF）”项目可即刻改善移动和平衡能力，并降低跌倒发生率，且能持续改善六个月，但该项目的出勤率受到限于在特定时间和地点获得课程、训练有素的指导者的成本和可用性等因素的限制。因此，我们开发并评估了 FFF 的在线网络版本，即“远离跌倒在线（FFFO）”。
30 名在过去两个月至少跌倒两次的 MS 患者被随机分配至 FFFO 组或对照组。FFFO 由 8 周的课程组成，每节课程都有教学和运动两部分。对照组患者收到了一份关于降低跌倒风险的小册子，同时给他们的主治医生寄了一封信，告知他们患者报告跌倒的情况，并邀请这些患者在研究结束时使用 FFFO 项目。研究的结果包括基线人口统计学数据、干预的 8 周和之后 3 个月内的前瞻性跌倒报告，以及主动组的项目满意度调查。回归模型用于测试治疗组和跌倒发生率之间的关联。
参与者的平均年龄为 55.8 岁，70%为女性，73%患有进展型 MS，中位扩展残疾状况量表（EDSS）评分为 6.0，在研究入组前一个月，参与者报告的跌倒次数中位数为 2 次。虽然一般来说，回归模型表明干预组患者跌倒的可能性低于对照组患者，但只有在事后模型评估天数平方与未跌倒概率之间的关系时，才达到统计学意义（p=0.0038）。该模型支持干预组患者跌倒的可能性略低于对照组患者。这种差异在研究的第一个月最为明显，在接下来的一个月不那么明显，且在干预后三个月没有持续。FFFO 的用户体验总体上是积极的，超过 75%的用户报告说网络程序易于学习和使用，85%的用户报告说程序易于遵循，62%的用户报告说材料有用，77%的用户发现锻炼是程序的有用组成部分。
本研究支持在 MS 中在线提供自我管理策略的可行性，表明 FFFO 可能有助于预防 MS 患者跌倒，并为使用 FFFO 对 MS 患者进行完全随机对照试验提供了初步数据，以验证本研究的结果。
