A falls prevention program for people with ms who fall: a feasibility pre-post intervention design

Abstract

Background: Preventing falls in people with Multiple Sclerosis (MS) is an important clinical issue. The prevalence of falls for people with MS is estimated to be between 50% and 63% (Finlayson et al., 2009; Coote et al., 2013). Despite this high incidence, fewer than 50 percent of people with MS receive information about falls prevention (Matsuda et al., 2011). There is currently limited evidence relating to the components of an optimal falls prevention programme for people with MS. Purpose: This pre-post intervention design examined the feasibility of delivering a falls prevention program specific to people with MS, who fall. Methods: Participants were recruited from the Southern AdelaideHealth Service and theMSSociety. PeoplewithMS with a history of falling, who were able to walk for 3meters, participated in a circuit group exercise and education program for 2 hours once a week over a 6 week period. The interventionwas designed to have an impact on balance (BergBalance Scale) and a range of secondary measures related to mobility, number of falls, self-efficacy, fatigue and quality of life. The exercises and education were delivered by a physiotherapist and a masters physiotherapy student. The exercises targeted activities such as strength, balance, walking practice through obstacle courses, getting on and off the floor and dual tasking. Education components focused on falls risk factors, identifying risks, what to do after a fall, factors that influence balance, the impact and management of fatigue, and action planning to identify falls factors relevant to each participant. Results:Fifteen participantswith amean age of 58.4 years ranging between 41 and 70 years of age were recruited to two group circuit training classes at two community locations. Mobility varied from walking independently without a walking aid (n= 6) to the use of a walking stick (n= 5) or a rollator walking frame (n= 4). Eight people completed all 6 classes with six people attending five classes, and one person completing 4 classes. Self reported confidence levels in balance (paired t-test: p= 0.028), and mobility (paired t-test: p= 0.047) were significant. The number of falls reported over a 3 month period post intervention reduced from a mean 2.93 (SD: 2.59) to 1.53 falls (SD: 2.59) demonstrating a positive trend (paired t-test: p= 0.06). By the end of the intervention, everyone was able to get on and off the floor safely with only two people requiring assistance. Conclusion(s): Feedback from the participants was positive with high attendance. The intervention was feasible and acceptable to participants with only two participants reporting that the exercises were too challenging; and one person reporting the exercises were too easy. These findings would need to be tested in larger numbers prior to funding any larger scale studies. Implications: The findings of this study provide promising results to add to the limited evidence base for falls prevention in people withMS. Delivering group circuit training for people with MS in the community is a resource efficient way to improve accessibility to therapy to improve balance and mobility in order to reduce falls.