Rice Laura A, Peterson Elizabeth W, Backus Deborah, Sung JongHun, Yarnot Rebecca, Abou Libak, Van Denend Toni, Shen Sa, Sosnoff Jacob J
Department of Kinesiology and Community Health, College of Applied Health Sciences, University of Illinois at Urbana-Champaign.
Department of Occupational Therapy, College of Applied Health Sciences, University of Illinois at Chicago, Chicago.
Medicine (Baltimore). 2019 May;98(19):e15418. doi: 10.1097/MD.0000000000015418.
Falls are a serious concern for wheelchair and scooter users with multiple sclerosis (MS). Approximately, 75% of the population reports at least one fall in a 6-month period and nearly half report frequent falls. Falls can result in physical injuries and contribute to activity curtailment. Despite the negative consequences, limited evidenced-based fall prevention programs designed specifically for wheelchair and scooter users with MS exist.
Recognizing the threat falls pose to health and well-being and the dearth of fall prevention programs, the purpose of this study is to perform a structured process evaluation and examine the feasibility and efficacy of a community-based intervention specifically designed to reduce fall incidence among wheelchair and scooter users with MS. Secondary aims of the intervention are to improve functional mobility skills associated with fall risk (e.g., transfer and wheelchair skills, balance), increase knowledge of fall risk factors, decrease fear of falling, and enhance quality of life and community participation.
To evaluate our specific aims, a clinical trial will be performed with 160 wheelchair and scooter users with MS. (ClinicalTrials.gov Identifier: NCT03705364). Participants will be recruited to participate in a small group-style community-based program. The content of the program will be based on factors found to be associated with falls among wheelchair and scooter users with MS. These factors include but are not limited to, wheelchair/scooter related characteristics, transfer activities, impaired seated balance, and environmental factors. A physical or occupational therapist, will implement the intervention, which is comprised of 6 sessions that occur once weekly. The incidence of falls, along with an examination of wheelchair/scooter and transfer skills, seated postural control and knowledge of fall related risk factors will be compared between intervention and control participants, with assessment periods occurring prior to the intervention, 1 to 2 weeks after completion of the 6-week intervention session, and 12 weeks after the intervention period is complete.
Results from this study will guide the refinement of the intervention program and inform future research among a large and diverse group of wheelchair and scooter users living with MS.
跌倒对于患有多发性硬化症（MS）的轮椅和踏板车使用者来说是一个严重问题。大约75%的此类人群报告在6个月内至少跌倒过一次，近一半的人报告经常跌倒。跌倒会导致身体受伤并限制活动。尽管有这些负面后果，但专门为患有MS的轮椅和踏板车使用者设计的基于证据的跌倒预防项目却很有限。
认识到跌倒对健康和幸福构成的威胁以及跌倒预防项目的匮乏，本研究的目的是进行结构化过程评估，并检验一项专门设计用于降低患有MS的轮椅和踏板车使用者跌倒发生率的社区干预措施的可行性和有效性。该干预措施的次要目标是提高与跌倒风险相关的功能移动技能（如转移和轮椅技能、平衡能力），增加对跌倒风险因素的认识，减少跌倒恐惧，并提高生活质量和社区参与度。
为了评估我们的具体目标，将对160名患有MS的轮椅和踏板车使用者进行一项临床试验。（ClinicalTrials.gov标识符：NCT03705364）。参与者将被招募参加一个小组式社区项目。该项目的内容将基于发现的与患有MS的轮椅和踏板车使用者跌倒相关的因素。这些因素包括但不限于与轮椅/踏板车相关的特征、转移活动、坐位平衡受损以及环境因素。一名物理治疗师或职业治疗师将实施该干预措施，该措施包括每周进行一次的6次课程。将比较干预组和对照组参与者之间的跌倒发生率，以及对轮椅/踏板车和转移技能、坐位姿势控制和跌倒相关风险因素知识的检查，评估期分别在干预前、6周干预课程结束后1至2周以及干预期结束后12周。
本研究的结果将指导干预项目的完善，并为未来对大量不同类型的患有MS的轮椅和踏板车使用者进行研究提供信息。
