Background

Falling is common in people with multiple sclerosis (MS) but tends to be under-ascertained and under-treated.

Objective

To evaluate fall risk in people with MS.

Methods

Ninety-four people with MS, able to walk > 2 min with or without an assistive device (Expanded Disability Status Scale (EDSS ≤ 6.5) were recruited. Clinic-based measures were recorded at baseline and 1 year. Patient-reported outcomes (PROs), including a fall survey and the MS Walking Scale (MSWS-12), were completed at baseline, 1.5, 3, 6, 9, and 12 months. Average daily step counts (STEPS) were recorded using a wrist-worn accelerometer.

Results

50/94 participants (53.2%) reported falling at least once. Only 56% of participants who reported a fall on research questionnaires had medical-record documented falls. Fallers had greater disability [median EDSS 5.5 (IQR 4.0–6.0) versus 2.5 (IQR 1.5–4.0), p < 0.001], were more likely to have progressive MS (p = 0.003), and took fewer STEPS (mean difference − 1,979, p = 0.007) than Non-Fallers. Stepwise regression revealed MSWS-12 as a major predictor of future falls.

Conclusions

Falling is common in people with MS, under-reported, and under-ascertained by neurologists in clinic. Multimodal fall screening in clinic and remotely may help improve patient care by identifying those at greatest risk, allowing for timely intervention and referral to specialized physical rehabilitation.

中文翻译：

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远程识别多发性硬化症患者跌倒

背景

跌倒在多发性硬化症 (MS) 患者中很常见，但往往未被充分确认和治疗。

客观的

评估 MS 患者的跌倒风险。

方法

招募了 94 名 MS 患者，在有或没有辅助装置的情况下行走 > 2 分钟（扩展残疾状态量表 (EDSS ≤ 6.5)）。在基线和 1 年时记录了基于临床的措施。患者报告的结果（PROs )，包括秋季调查和 MS 步行量表 (MSWS-12)，在基线、1.5、3、6、9 和 12 个月完成。使用腕戴式加速度计记录平均每日步数 (STEPS)。

结果

50/94 名参与者 (53.2%) 报告至少跌倒过一次。在研究问卷中报告跌倒的参与者中，只有 56% 的医疗记录记录了跌倒。跌倒者有更大的残疾 [EDSS 中位数 5.5 (IQR 4.0–6.0) 与 2.5 (IQR 1.5–4.0)，p  < 0.001]，更有可能患有进行性 MS ( p  = 0.003)，并且走的步数更少（平均差 - 1,979 , p  = 0.007) 高于非失败者。逐步回归显示 MSWS-12 是未来跌倒的主要预测指标。

结论

跌倒在多发性硬化症患者中很常见，临床上的神经科医生报告不足，也未得到充分确认。诊所和远程的多模式跌倒筛查可以通过识别风险最大的人来帮助改善患者护理，从而及时干预并转诊到专门的身体康复中心。