This study aimed to identify risk factors that independently affect patients who report multiple falls.
This cross-sectional mail survey included 1,000 members of the Japanese Spinocerebellar Degeneration and Multiple System Atrophy (MSA) patient association. The exclusion criteria were as follows: those who were not patients with CA, those under 18 years of age, those living outside their homes, and those with severe disability (modified Rankin Scale [mRS] of 5). The number of falls per year was collected, and the presence or absence of two or more falls was adopted as the primary outcome. In addition, the following variables that may be related to falls were extracted; age, sex, body mass index, educational background, disease type, disease duration, general and disease-related complications, medication use, cohabitation, caregiver support, fear of falling, mRS, Barthel Index, Life-Space Assessment, indoor and outdoor mobilities, Patient Health Questionnaire-2, self-reported symptoms [0-3 point scale] such as ataxia, weakness, rigidity, imbalance, malalignment, fatigue, pain, sensory disturbance, orthostatic hypotension, visual and cognitive impairment. These data were supplemented by multiple imputations for missing values. Univariate binary logistic analyses were conducted for all independent variables, with the dependent variable as the presence or absence of multiple falls. Then, multivariate binary logistic regression analysis was conducted on the independent variables that were significant at p 0.05 in the univariate analysis. In this case, age and sex were forced into the model, and other variables were reduced using the likelihood ratio method, with a 0.05 threshold for inclusion and exclusion. All statistical analyses were conducted using SPSS version 28.
The analysis included 353 participants (mean age 64.7±12.6 years; 43.9% female; mean disease duration 14.1±11.8 years). As a result of multivariate logistic analysis, the following four variables were found to be independently associated with multiple falls: age (Odds Ratio[OR] 0.96, p = 0.001), imbalance (OR 1.50, p = 0.025), malalignment (OR 1.37, p = 0.055), and cognitive impairment (OR 1.72, p = 0.015).
The results show that patients with higher age and self-reported imbalance, malalignment, and cognitive impairment are more likely to have multiple falls. Further verification using prospective data is necessary for predicting falls.
Individualized care based on risk assessment for balance disorders, postural abnormalities, and cognitive impairment may help prevent falls in patients with CA.
Falls
Questionnaire
