Objective:
More than 50% of people with MS fall within a three-month period and over a third of these are recurrent fallers (Nilsagård et al. 2015). A recent systematic review (Gunn et al. 2013) found mobility aid use and balance impairments are factors associated with an increased risk of falls. In clinical practice balance outcome measures are routinely administered to determine falls risk. The aim of this review is to determine the ability of commonly used clinical measures of balance to distinguish fallers from non-fallers and to determine their predictive validity in identifying those at risk of future falls.
Methods:
Ebsco, Scopus and Pubmed Central were systematically searched using a combination of keywords and search terms. Reference lists of included studies were also examined. Inclusion criteria were studies of adults with a definite MS diagnosis, a clinical balance assessment (both objective and subjective measures) and a method of falls recording. Data were extracted independently by two reviewers. Study quality was assessed using validated criteria and statistical analysis was conducted for the appropriate variables using Review Manager 5. The mean difference with 95% confidence interval in balance outcomes between fallers and non-fallers was used as the mode of analysis.
Results:
We included 29 studies (17 cross sectional, 5 randomised controlled trials, 7 prospective) with a total of 3304 participants, of which 1629 (49%) were classified as fallers. The balance measures most commonly reported were the Berg Balance Scale (N=9), Timed up and Go (N=9) and Falls Efficacy Scale- International (N=7). Meta-analysis demonstrated fallers perform significantly worse than non-fallers on these measures (p<0.05) but discriminative ability of the measures is commonly not reported and when reported can be considered poor.
Conclusion:
There are a growing number of prospective studies evaluating falls risk in MS but no one measure has been shown to have reliable clinical utility and discriminative ability in predicting future risk of falls. It is not possible to recommend any clinical balance measure for assessing falls risk in MS at present. Future research in this area needs to use standardised methods to conduct and report study findings including prospective falls recording.
References:
Gunn, H.J., Newell, P., Haas, B., Marsden, J.F. and Freeman, J.A. (2013) 'Identification of risk factors for falls in multiple sclerosis: A systematic review and meta-analysis', Physical Therapy, 93(4), 504.
Nilsagård, Y., Gunn, H., Freeman, J., Hoang, P., Lord, S., Mazumder, R. and Cameron, M. (2015) 'Falls in people with MS—an individual data meta-analysis from studies from Australia, Sweden, United Kingdom and the United States', Multiple Sclerosis, 21(1), 92-100.
Ethical Approval:
Exempt as this is a systematic review design.
