FACTORS AFFECTING FALLS IN PEOPLE WITH MULTIPLE SCLEROSIS; MODERATION AND MEDIATION EFFECT OF FATIGUE AND BALANCE ON FALLS; A CASE-CONTROL STUDY

F. Khan¹, A. Jawad², B. Baattaiah¹, M. Alharbi¹, M.F. Chevidikunnan¹

¹King Abdulaziz University, Physical Therapy, Jeddah, Saudi Arabia, ²King Fahad Hospital, Physical Therapy, Jeddah, Saudi Arabia

Background: Prevalence of Multiple Sclerosis (MS) has been significantly increased in the last decades. Persons with MS (PwMS) are at high risk of falls; these falls may lead to serious injuries affecting the quality of life.

Purpose: This study aimed to assess the factors affecting falls in PwMS and mapping out the most significant ones. Also to find whether fatigue has a moderator effect and balance has a mediator effect on falls in PwMS.

Methods: One hundred and three PwMS with a mean age of (32.09 ± 7.17) were enrolled. All subjects were assessed for different variables including balance using Berg balance scale (BBS), speed of gait using timed up and go test (TUG), fear of falling using falls efficacy scale international (FES-I), level of fatigue using modified fatigue impact scale (MFIS) and hand held digital dynamometer for assessing lower limb muscle strength.

Results: Simple binary logistic regressions analysis showed a significant result for BBS (OR: 10.88; 95% CI: 4.24 – 27.96; p <0.0001), TUG (OR: 1.18, 95%; CI: 1.09 - 1.28; p <0.0001), FES-I (OR: 1.06; 95% CI: 1.02 - 1.10; p = 0.001), MFIS (OR: 1.04; 95% CI: 1.02 - 1.07; p <0.0001) as the factors affecting falls.
In multivariable analysis balance, speed of gait and fatigue were the most predicting factors for falls. BBS (OR: 3.924; 95% CI: 1.307 - 11.780, p =0.015), TUG (OR: 1.122; 95% CI: 1.023 - 1.231; p =0.015) and MFIS (OR: 1.029; 95% CI: 1.002 - 1.058; p =0.038).
HAYES PROCESS analysis showed a significant moderation effect of fatigue on gait speed and falls (MFIS; effect; 0.10; p <0.0001; 95% CI, 0.07 to 0.14). And the mediation effect of balance on gait speed and falls (BBS; indirect effect; 0.08; 95% CI, 0.02 to 0.13).

Conclusions: Speed of gait, Balance and Fatigue are the most significant variables in the prediction of falls in PwMS. Fatigue has a significant moderator effect and balance plays a significant mediator effect on falls in PwMS.

Implications: Understanding the factors affecting falls in PwMS adds to the fundamental knowledge pertaining to the therapeutic strategies to develop fall prevention programmes and thereby improve the quality of life in PwMS.

Funding acknowledgements: Not applicable

Keywords:
Multiple Sclerosis
Falls
Factors

Topics:
Neurology: multiple sclerosis
Neurology

Did this work require ethics approval? Yes

Institution: Ministry Of Health

Committee: Institutional Review Board – Ministry Of Health, Jeddah

Ethics number: H-02-J-002