Fear of falling and concern about falling in individuals with relapsing-remitting MS and progressive MS

Abstract

Background and Purpose Falls and fear of falling (FOF) in multiple sclerosis (MS) are highly prevalent issues. Previously, FOF and concern about falling (CAF) have been used interchangeably; however, persons with MS report that FOF is different than CAF. Therefore, our objective was to examine prevalence and relations of FOF and CAF to function in relapsing-remitting MS (RRMS) and progressive MS (PMS). Methods In an online survey, 1025 participants with MS indicated their FOF (yes/no) and CAF (yes/no), rated how they felt on a scale of no concern (0) to fearful (4) during 28 activities (the CF-Fall), and completed physical, cognitive, and psychological measures. Pearson's correlations were used to examine relations among the CF-Fall with other measures. In persons endorsing FOF and CAF, independent t-tests were used to compare functioning between subtypes. Results Overall, 60.2% of subjects reported that FOF and CAF are different constructs and 47.2% reported FOF (yes/no) and 64.6% reported CAF (yes/no). PMS reported greater FOF (59.1%) and CAF (80.1%) than RRMS (41.6% and 57.0%, respectively). Avoidance behavior (r = .82, p < .001), walking impairment (r = .83, p < .001), physical function (r = -.84, p < .001), and lower extremity function (r = -.85, p < .001) were most correlated to the CF-Fall. People with PMS endorsing FOF and CAF demonstrated greater FOF on the CF-Fall, greater avoidance behavior, poorer walking ability, physical function, life-space mobility, lower extremity function, but greater cognitive function than RRMS (all, p < .001). Discussion These findings underscore the disparity between FOF and CAF, emphasize the importance of evaluating FOF and CAF in MS subtypes separately, as rates for the whole sample may underestimate the prevalence in PMS, and highlight non-motor factors contributing to FOF and CAF. Future work should focus on interventions that incorporate motor, cognitive, and psychological components to address FOF and CAF. Falls and fear of falling (FOF) in multiple sclerosis (MS) are highly prevalent issues. Previously, FOF and concern about falling (CAF) have been used interchangeably; however, persons with MS report that FOF is different than CAF. Therefore, our objective was to examine prevalence and relations of FOF and CAF to function in relapsing-remitting MS (RRMS) and progressive MS (PMS). In an online survey, 1025 participants with MS indicated their FOF (yes/no) and CAF (yes/no), rated how they felt on a scale of no concern (0) to fearful (4) during 28 activities (the CF-Fall), and completed physical, cognitive, and psychological measures. Pearson's correlations were used to examine relations among the CF-Fall with other measures. In persons endorsing FOF and CAF, independent t-tests were used to compare functioning between subtypes. Overall, 60.2% of subjects reported that FOF and CAF are different constructs and 47.2% reported FOF (yes/no) and 64.6% reported CAF (yes/no). PMS reported greater FOF (59.1%) and CAF (80.1%) than RRMS (41.6% and 57.0%, respectively). Avoidance behavior (r = .82, p < .001), walking impairment (r = .83, p < .001), physical function (r = -.84, p < .001), and lower extremity function (r = -.85, p < .001) were most correlated to the CF-Fall. People with PMS endorsing FOF and CAF demonstrated greater FOF on the CF-Fall, greater avoidance behavior, poorer walking ability, physical function, life-space mobility, lower extremity function, but greater cognitive function than RRMS (all, p < .001). These findings underscore the disparity between FOF and CAF, emphasize the importance of evaluating FOF and CAF in MS subtypes separately, as rates for the whole sample may underestimate the prevalence in PMS, and highlight non-motor factors contributing to FOF and CAF. Future work should focus on interventions that incorporate motor, cognitive, and psychological components to address FOF and CAF.