Perceptions of Fall Risk as Important as Physical Limitations and Need Be Part of Risk Assessment, Study Says

Perceptions of Fall Risk as Important as Physical Limitations and Need Be Part of Risk Assessment, Study Says

For ambulatory multiple sclerosis patients with mobility problems, perceptions of being at risk of falling are as important as the risk due to their physical condition — and both should be tested when evaluating fall risk in this patient population, a study reports.

The study, “The relationship between physiological and perceived fall risk in people with multiple sclerosis: Implications for assessment and management,” was published in the journal Archives of Physical Medicine and Rehabilitation.

Impaired mobility is among the concerns voiced most by MS patients, and one with a significant impact on quality of life. Impaired balance and falls are common in these patients.

Prior studies have suggested that identifying those at a higher risk for falls — called individualized fall risk-factor identification — is important for developing targeted interventions during rehabilitation that optimize outcomes.

Risk factors for falls in MS patients are both physiological —  gait disturbance, spasticity (continuous contraction of certain muscles, stiffening them), slow reaction time, and increased postural sway — and psychological, such as fear of falling.

Physiological attributes that contribute to a higher risk of fall are measured using a test called the Physiological Profile Assessment (PPA), which assesses such factors as muscle strength of the lower limbs and reaction time, and psychological ones using the Falls Efficacy Scale-international (FESi) 16-item questionnaire. Both tests have been validated as appropriate for measuring the risk of falls.

Researchers, looking to better understand the relationship between perceived (psychological) and physiological fall risk in MS, looked at 416 ambulatory MS patients from the United States, Australia, and United Kingdom. All had completed the PPA and the FESi tests, and kept track of their falls for three months.

Results showed that 155 patients were recurrent fallers, defined as two or more falls in the three months both prior to and after the study’s start. The mean PPA and FESi scores of these people were also high, and both tests independently predicted them as likely to frequently fall. Essentially, the higher the scores on these tests, the higher the odds of being classified as a recurrent faller.

Patients were then divided into four groups based on their PPA and FESi scores. Group 1 included 119 patients with both low physiological and perceived risk, group 2 included 169 patients with low physiological but high perceived risk; group 3 included 42 patients with high physiological but low perceived risk; and group 4 included 86 patients with high physiological and perceived risk.

More than half of patients analyzed showed a significant disparity between perceived and physiological fall risk, and most of these people were in group 2. In this group, despite being at low physiological risk of falling, 37.3% were recurrent fallers.

“In our analysis, 63 (37%) of the participants in Group 2 (low physiological/ high perceived risk) were classified as recurrent fallers, which represents 41% of recurrent fallers across the whole cohort,” the researchers wrote. “Although these individuals were classified by the PPA as having ‘low’ physiological risk, the cut-off point (2.83) was relatively high and it is likely that for at least some of them, physiological factors in addition to those assessed by the PPA contributed to fall risk.”
Physiological risk factors not “captured” in the PPA test, they added, include “impaired gait, spasticity and dual task interference” all of which “have all been identified as fall risk factors in prospective MS cohort studies.”

Overall, the results highlight “the importance of considering both physiological and perceived fall risk in MS and the need for further research to explore the complex interrelationships of perceptual and physiological risk factors in this population,” the researchers wrote.

The team hopes these findings can be used to guide individualized assessment and the development of tailored fall risk management strategies.


  1. Susan Scott says:

    Can you please define dual task interference with real life example =like when a person has to balance a leg and reach for a door etc.?

  2. Betty Beem says:

    I feel I am realistic about my fall risks. This is especially important as I have no cartilage in my left knee and wear a leg brace which helps with diminishing the risk of falling. I also have a depth perception issue which means I do not perceive dips in the pavement, depth of a curb, or height of stairs. I always use a cane in new physical environments. Once I’m familiar with a new environment, the cane is no longer necessary. Falls are more dangerous than many acknowledge. Even jolts to the brain can have a cumulative effect. People with MS do not need to add brain trauma to their lists of physical conditions.

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