Reducing falls and improving mobility in multiple sclerosis

Abstract

Falls are common in persons with multiple sclerosis (MS), and are related to physical injury and reduce the quality of life. Mobility impairments are a significant risk factor for falls in persons with MS. Although there is evidence that mobility in persons with MS can be improved with rehabilitation, much less is known about fall prevention. This review focuses on fall prevention in persons with MS. Ten fall prevention interventions consisting of 524 participants with a wide range of disability were systematically identified. Nine of the 10 investigations report a reduction in falls and/or proportion of fallers following treatment. The vast majority observed an improvement in balance that co-occurred with the reduction in falls. Methodological limitations preclude any firm conclusions. Numerous gaps in the understanding of fall prevention in persons with MS are discussed. Well-designed randomized control trials targeting mobility and falls are warranted.

Keywords:

• balance
• clinical trials
• exercise
• falls prevention
• locomotion
• mobility
• rehabilitation
• walking

Acknowledgements

The authors extend their gratitude to R Motl and DA Wajda for their insightful comments on the manuscript.

Financial & competing interests disclosure

JJ Sosnoff has received funding from National Multiple Sclerosis Society and Consortium of MS Centers. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Key issues

• Falls are a significant health concern in persons with multiple sclerosis.

• Impairments in mobility are a significant risk factor.

• Five hundred and twenty four participants have volunteered in 10 fall prevention interventions, with over 70% participating in exercise-based trials.

• Evidence from interventions targeting mobility in persons with multiple sclerosis suggests that the number of falls/proportion of fallers can be reduced across a range of disability levels and rehabilitation approaches and settings.

• Methodological limitations preclude any firm conclusions.

• Well-designed randomized control trials targeting mobility and falls are needed.