Department of Physical Therapy, Faculty of Medical Rehabilitation Sciences, King Abdulaziz University, P.O. Box 80200, Jeddah 21589, Saudi Arabia; Department of Physical Therapy, King Fahad Hospital, Jeddah, Saudi Arabia.
Department of Physical Therapy, Faculty of Medical Rehabilitation Sciences, King Abdulaziz University, P.O. Box 80200, Jeddah 21589, Saudi Arabia.
Mult Scler Relat Disord. 2023 Aug;76:104838. doi: 10.1016/j.msard.2023.104838. Epub 2023 Jun 18.
The prevalence of multiple sclerosis (MS) has significantly increased in recent decades. People with MS have a high risk of falling; these falls may lead to serious injuries, affecting their quality of life PURPOSE: The aim of this study is to assess the factors affecting falls in people with MS and map out the most significant ones. This study also aims to determine whether fatigue has a moderation effect and balance has a mediation effect on falls in people with MS METHODS: In total, 103 people with MS with a mean age of 32.09 ± 7.17 were enrolled. All subjects were assessed for multiple variables including balance using the Berg Balance Scale (BBS), speed of gait using the Timed Up and Go (TUG) test, fear of falling using the Falls Efficacy Scale-International (FES-I), level of fatigue using the Modified Fatigue Impact Scale (MFIS), and lower limb muscle strength using a handheld digital dynamometer RESULTS: Simple binary logistic regression analysis showed significant results for BBS (OR: 10.88; 95% CI: 4.24-27.96; p < 0.0001), TUG (OR: 1.18; 95% CI: 1.09-1.28; p < 0.0001), FES-I (OR: 1.06; 95% CI: 1.02-1.10; p = 0.001), and MFIS (OR: 1.04; 95% CI: 1.02-1.07; p < 0.0001) as factors affecting falls. According to multivariate analysis, balance (OR: 3.924; 95% CI: 1.307-11.780, p = 0.015), speed of gait (OR: 1.122; 95% CI: 1.023-1.231; p = 0.015), and fatigue (OR: 1.029; 95% CI: 1.002-1.058; p = 0.038) were the strongest predicting factors of falls. Hayes's PROCESS analysis showed that fatigue had a significant moderation effect on the relationship between gait speed and falls (MFIS; β; 0.10; p < 0.0001; 95% CI: 0.07-0.14) and balance had a mediation effect on the relationship between gait speed and falls (BBS; indirect effect; 0.08; 95% CI: 0.02-0.13) CONCLUSIONS: People with MS with impaired balance, slower gait speeds, higher levels of fatigue, and a fear of falling were at a high risk of falling. The relationship between gait speed and falls can be mediated by impaired balance and moderated by the level of fatigue. Our data suggest that targeting balance and fatigue while developing rehabilitation interventions could decrease the incidence of falls among people with MS.
多发性硬化症 (MS) 的患病率在近几十年来显著增加。MS 患者有很高的跌倒风险；这些跌倒可能导致严重伤害，影响他们的生活质量。
本研究旨在评估影响 MS 患者跌倒的因素，并绘制出最重要的因素。本研究还旨在确定疲劳是否对 MS 患者的跌倒有调节作用，平衡是否对跌倒有中介作用。
共纳入 103 名平均年龄为 32.09±7.17 岁的 MS 患者。所有受试者均接受了多项变量评估，包括使用 Berg 平衡量表 (BBS) 评估平衡、使用计时起立行走测试 (TUG) 评估步态速度、使用跌倒效能量表-国际版 (FES-I) 评估跌倒恐惧、使用改良疲劳影响量表 (MFIS) 评估疲劳程度以及使用手持数字测力计评估下肢肌肉力量。
简单二元逻辑回归分析显示 BBS（OR：10.88；95%CI：4.24-27.96；p<0.0001）、TUG（OR：1.18；95%CI：1.09-1.28；p<0.0001）、FES-I（OR：1.06；95%CI：1.02-1.10；p=0.001）和 MFIS（OR：1.04；95%CI：1.02-1.07；p<0.0001）是影响跌倒的显著因素。根据多变量分析，平衡（OR：3.924；95%CI：1.307-11.780，p=0.015）、步态速度（OR：1.122；95%CI：1.023-1.231；p=0.015）和疲劳（OR：1.029；95%CI：1.002-1.058；p=0.038）是跌倒的最强预测因素。Hayes 的 PROCESS 分析表明，疲劳对步态速度和跌倒之间的关系具有显著的调节作用（MFIS；β；0.10；p<0.0001；95%CI：0.07-0.14），平衡对步态速度和跌倒之间的关系具有中介作用（BBS；间接效应；0.08；95%CI：0.02-0.13）。
平衡受损、步态速度较慢、疲劳程度较高和恐跌的 MS 患者跌倒风险较高。步态速度与跌倒之间的关系可以通过平衡受损和疲劳程度来调节。我们的数据表明，在制定康复干预措施时，针对平衡和疲劳进行干预，可能会降低 MS 患者跌倒的发生率。
