This study investigates the potential of passive monitoring of gait and turning in daily life in people with multiple sclerosis (PwMS) to identify those at future risk of falls. Seven days of passive monitoring of gait and turning were carried out in a pilot study of 26 PwMS in home settings using wearable inertial sensors. The retrospective fall history was collected at the baseline. After gait and turning data collection in daily life, PwMS were followed biweekly for a year and were classified as fallers if they experienced >1 fall. The ability of short-term passive monitoring of gait and turning, as well as retrospective fall history to predict future falls were compared using receiver operator curves and regression analysis. The history of retrospective falls was not identified as a significant predictor of future falls in this cohort (AUC = 0.62, p = 0.32). Among quantitative monitoring measures of gait and turning, the pitch at toe-off was the best predictor of falls (AUC = 0.86, p < 0.01). Fallers had a smaller pitch of their feet at toe-off, reflecting less plantarflexion during the push-off phase of walking, which can impact forward propulsion and swing initiation and can result in poor foot clearance and an increased metabolic cost of walking. In conclusion, our cohort of PwMS showed that objective monitoring of gait and turning in daily life can identify those at future risk of falls, and the pitch at toe-off was the single most influential predictor of future falls. Therefore, interventions aimed at improving the strength of plantarflexion muscles, range of motion, and increased proprioceptive input may benefit PwMS at future fall risk.

中文翻译：

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基于多发性硬化症患者日常生活中步态和转身的仪器测量的跌倒预测

本研究调查了多发性硬化症 (PwMS) 患者在日常生活中被动监测步态和转身的潜力，以确定未来有跌倒风险的人。在家庭环境中使用可穿戴惯性传感器对 26 PwMS 进行初步研究，对步态和转弯进行了 7 天的被动监测。在基线收集回顾性跌倒史。在日常生活中收集步态和转弯数据后，PwMS 每两周进行一次跟踪，为期一年，如果跌倒 > 1 次，则被归类为跌倒者。使用接受者操作曲线和回归分析比较了短期被动监测步态和转身的能力，以及预测未来跌倒的回顾性跌倒历史。p = 0.32）。在步态和转弯的定量监测措施中，脚趾离地的间距是跌倒的最佳预测指标（AUC = 0.86，p< 0.01)。摔倒者在脚趾离地时脚的间距较小，反映出在步行的推离阶段跖屈较少，这会影响向前推进和摆动启动，并可能导致脚部间隙差和步行的代谢成本增加。总之，我们的 PwMS 队列表明，客观监测步态和日常生活中的转身可以识别那些未来有跌倒风险的人，而脚趾离地的倾斜度是未来跌倒的最有影响力的预测指标。因此，旨在改善跖屈肌肉力量、运动范围和增加本体感受输入的干预措施可能有益于未来跌倒风险的 PwMS。