Department of Physical Medicine & Rehabilitation, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA.
Department of Kinesiology & Community Health, College of Applied Health Sciences, University of Illinois at Urbana-Champaign, Urbana, IL, USA.
Neurorehabil Neural Repair. 2022 Dec;36(12):757-769. doi: 10.1177/15459683221131791. Epub 2022 Nov 1.
BACKGROUND: Mobility and cognitive impairments are often associated with increased fall risk among people with multiple sclerosis (PwMS). However, evidence on the concurrent assessment of gait or balance and cognitive tasks (dual-task) to predict falls appears to be inconsistent. OBJECTIVE: To summarize the ability of gait or balance dual-task testing to predict future falls among PwMS. METHODS: Seven databases including PubMed, Embase, Web of Science, Scopus, CINHAL, SPORTDiscuss, and PsycINFO were searched from inception to May 2022. Two independent reviewers identified studies that performed a dual-task testing among adults with multiple sclerosis and monitored falls prospectively for at least 3 months. Both reviewers also evaluated the quality assessment of the included studies. RESULTS: Eight studies with 484 participants were included in the review. Most studies (75%) indicated that dual-task testing and dual-task cost did not discriminate prospective fallers (⩾1 fall) and non-fallers (0 fall) and were not found as predictors of future falls. However, dual-task cost of walking velocity (OR = 1.23, 95% CI 0.98-4.45, = .05) and dual-task of correct response rate of serial 7 subtraction (OR = 1.34, 95% CI 1.04-3.74, = .02) were significantly associated with increased risk of recurrent falls (≥2 falls). Pattern of cognitive-motor interference was also associated with an increased risk of falling. All studies presented with strong quality. CONCLUSION: The scarce evidence indicates that dual-task testing is not able to predict future falls among PwMS. Further research with more complex motor and cognitive tasks and longer-term fall monitoring is required before dual-task testing can be recommended as a predictor of future falls in this population.
背景:行动和认知障碍通常与多发性硬化症患者(PwMS)的跌倒风险增加有关。然而,关于步态或平衡与认知任务(双重任务)同时评估以预测跌倒的证据似乎不一致。
目的:总结步态或平衡双重任务测试预测 PwMS 未来跌倒的能力。
方法:从建库到 2022 年 5 月,我们在 7 个数据库(包括 PubMed、Embase、Web of Science、Scopus、CINHAL、SPORTDiscuss 和 PsycINFO)中进行了搜索。两名独立的审查员确定了在多发性硬化症成年人中进行双重任务测试并前瞻性监测至少 3 个月跌倒情况的研究。两名审查员还评估了纳入研究的质量评估。
结果:共纳入 8 项包含 484 名参与者的研究。大多数研究(75%)表明,双重任务测试和双重任务成本不能区分前瞻性跌倒者(≥1 次跌倒)和非跌倒者(0 次跌倒),也不能作为未来跌倒的预测指标。然而,行走速度的双重任务成本(OR=1.23,95%CI 0.98-4.45,=0.05)和连续 7 次减法正确反应率的双重任务(OR=1.34,95%CI 1.04-3.74,=0.02)与复发性跌倒(≥2 次跌倒)的风险增加显著相关。认知运动干扰模式也与跌倒风险增加相关。所有研究的质量都很高。
结论:目前证据表明,双重任务测试不能预测 PwMS 的未来跌倒。在双重任务测试能够被推荐为该人群未来跌倒的预测指标之前,还需要进行更多复杂的运动和认知任务以及长期跌倒监测的研究。
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