File
Nilsagård Y.1,2, Carling A.1,3, Forsberg A.1,3
1Örebro University, Faculty of Medicine and Health, Örebro, Sweden, 2Region Örebro County, Health Care Management, Örebro, Sweden, 3Örebro University Hospital, Department of Physiotherapy, Örebro, Sweden
Background: People with multiple sclerosis (PwMS) fall frequently. In an individual meta-analysis; 56% reported ≥1fall during a 3-months period 1. Fall risk is multifactorial including both internal and external factors 2. Consequently, people with increased fall risk should preferably be managed by a multi professional team (patient included). Physiotherapists with expertise in neurology should contribute with targeted interventions.The CoDuSe balance exercise program targets core stability, dual tasking and sensory strategies. Sixty-minute sessions are provided twice weekly over 7 weeks in groups of 3 to 7 people. The CoDuSe program relies on skilled physiotherapists who are able to individualize and adjust the level of difficulty of the exercises. It has been evaluated in two samples of PwMS 3,4 where participants were randomized to either early or late intervention start using a waiting list design. Falls were self-reported on a daily basis using fall diaries during the intervention period and during 7 weeks of follow-up. In addition, those starting intervention late in each study also reported falls during a 7-week period prior to intervention start. Analyses of falls using pre intervention falls data were thus limited to subgroups in the respective study.
Purpose: To evaluate the falls reductive effect of the CoDuSe exercise program in a larger sample.
Methods: A combined data set using the two subgroups starting late with intervention was created. Fifty-three PwMS (60% females) were included. The mean age was 55.4 years and 70% had either primary or secondary progressive MS. All had limited but remained (at least 100m) walking ability and impaired balance function. Comparisons between periods were performed for the number of fallers (McNemar) and falls (Mann Whitney U-test).
Results: 33 participants reported ≥1 fall before intervention start; 27 during the intervention period and 16 during the follow-up period. A statistically significant decrease in the numbers of fallers was found between before intervention and follow-up (p≤0.001) and between during intervention and follow-up (p≤ 0.013) but not between before and during intervention (p≤0.210).256 falls were reported before intervention; 122 during the intervention period and 80 during the follow-up period. The reduction of falls from study start to study ending was in total 176 falls (p≤0.001). A statistically significant decrease in the number of falls was also found for between before vs during (p≤0.001) and during vs follow-up (p≤0.012).
Conclusion(s): Seven weeks of twice weekly CoDuSe balance exercise program reduces number of falls and fallers in PwMS with limited walking ability and imbalance.
Implications: Physiotherapists can contribute to lower fall frequencies in PwMS using the CoDuSe balance exercise program.
Funding acknowledgements: The Regional Research Committee Grant no RFR-218351, the Örebro Research Committee (grant no OLL-216421), the Norrbacka Eugenia Foundation (814/12)
Topic: Neurology: multiple sclerosis
Ethics approval: Original studies were approved by the Regional Ethics Committee in Uppsala-Örebro (2012/117 and 2014/302).
All authors, affiliations and abstracts have been published as submitted.
