International MS Falls Prevention Research Network: Report from the Front Lines.

Abstract

In a given year, nearly 60% of individuals with multiple sclerosis (MS) will experience a fall. A significant portion of these falls will result in an injury, ranging from mild bruising to bone fractures. Perhaps more insidious than any physical injuries are the reduced activity, fear of falling, and social isolation to which falls may contribute. Falls and their consequences are important targets of rehabilitation. Yet, despite the work of several individual research teams around the world, scientific knowledge about effective ways to reduce the number, severity, and consequences of falls experienced by people with MS is in its infancy. Overcoming this problem will require international collaboration and partnership that pools interdisciplinary expertise and produces evidence about the best approaches to reduce fall frequency, severity, and consequences for people with MS. In order to facilitate this collaboration and partnership, a group of seven MS researchers secured a planning grant from the Canadian Institutes of Health Research to support an inaugural meeting of the International MS Falls Prevention Research Network (IMSFPRN). Our grant team includes Principal Investigator Marcia Finlayson (Queen's University, Kingston, Ontario, Canada) and Co-Investigators (in alphabetical order) Michelle Cameron (Department of Neurology, Oregon Health & Science University, and Portland VA Medical Center, Portland, OR, USA), Davide Cattaneo (Don C. Gnocchi Foundation, Milan, Italy), Susan Coote (University of Limerick, Limerick, Ireland), Patricia N. Matsuda (University of Washington, Seattle, WA, USA), Elizabeth Peterson (University of Illinois at Chicago, Chicago, IL, USA), and Jacob J. Sosnoff (University of Illinois at Urbana-Champaign, Urbana, IL, USA). The founding members of the IMSFPRN, and those who may join in the future, will work collaboratively to develop and implement multisite research protocols to advance knowledge on falls and falls prevention among people with MS. The overarching goals of the initial meeting were as follows: 1) to build collaborative partnerships among researchers, clinicians, consumers, and other key stakeholders committed to strengthening evidence for MS falls prevention, and 2) to begin work on a protocol for an MS falls-prevention intervention trial. The long-term goal of the IMSFPRN is to develop and disseminate clinically relevant knowledge that will reduce the frequency, severity, and functional consequences of falls experienced by people with MS worldwide. The inaugural meeting was held at Queen's University in Kingston, Ontario, Canada, in March 2014. In addition to the IMSFPRN founding members, the meeting was attended by clinicians from a variety of fields (neurology, physical therapy, occupational therapy, nursing, kinesiology); experts in aging with MS, physical activity and disability, and postural control in older adults; individuals living with MS; and representatives from the Canadian Association of Occupational Therapists, the Canadian Physiotherapy Association, and the Multiple Sclerosis Society of Canada. Through-out the meeting, all participants had opportunities and were encouraged to share their ideas and expertise regarding the key elements of the falls-prevention intervention protocol that the IMSFPRN is developing. These opportunities were made possible through presentations, small- and large-group discussions, and formal nominal group methods. This theme issue of the International Journal of MS Care focuses on the recommendations concerning falls prevention that emerged from the March 2014 meeting of the IMSFPRN. An article by Ploughman et al. focuses on how research on postural control of older adults, physical activity promotion for people with spinal cord injury, and aging with MS can and should inform falls-prevention research in MS. Cameron et al. detail which people with MS should be targeted for falls-prevention trials. Gunn and colleagues discuss the advantages and disadvantages of various settings for falls-prevention trials that can be implemented for people with MS. Other articles provide the rationale and potential measurement tools for the three key outcomes the meeting participants identified for an MS falls-prevention intervention: number of falls (Coote et al.), dynamic balance (Cattaneo et al.), and participation (Finlayson et al.). Finally, Finlayson et al. examine how the RE-AIM framework can inform the ongoing work of the IMSFPRN in order to maximize the uptake of the evidence we plan to produce in the years to come. There is little doubt that determining best practices in falls prevention specific to people with MS is essential. This theme issue outlines an international effort to lay the foundation for falls-prevention research. As members of the IMSFPRN, our goal is to work together to maximize falls-prevention research efforts. We hope that this theme issue will encourage others to join our group in our effort to reduce the frequency, severity, and functional consequences of falls in people with MS. If you are interested in joining the Network or being kept abreast of our activities, please contact Marcia Finlayson at ac.usneeuq@nosyalnif.aicram.