title: Understanding falls in multiple sclerosis: association of mobility status, concerns about falling, and accumulated impairments.
abstract: BACKGROUND
  Falls in people with multiple sclerosis (MS) are a serious health concern, and the percentage of people who restrict their activity because of concerns about falling (CAF) is not known. Mobility function and accumulated impairments are associated with fall risk in older adults but not in people with stroke and have not been studied in people with MS.
  
  
  OBJECTIVE
  The purposes of this study were: (1) to estimate the percentage of people who have MS and report falling, CAF, and activity restrictions related to CAF; (2) to examine associations of these factors with fall status; and (3) to explore associations of fall status with mobility function and number of accumulated impairments.
  
  
  METHODS
  A cross-sectional survey was conducted.
  
  
  METHODS
  A total of 575 community-dwelling people with MS provided information about sociodemographics, falls, CAF, activity restrictions related to CAF, mobility function, and accumulated impairments. Chi-square statistics were used to explore associations among these factors.
  
  
  RESULTS
  In all participants, about 62% reported CAF and about 67% reported activity restrictions related to CAF. In participants who did not experience falls, 25.9% reported CAF and 27.7% reported activity restrictions related to CAF. Mobility function was associated with fall status; participants reporting moderate mobility restrictions reported the highest percentage of falls, and participants who were nonwalkers (ie, had severely limited self-mobility) reported the lowest percentage. Falls were associated with accumulated impairments; the participants who reported the highest percentage of 2 or more falls were those with 10 impairments.
  
  
  CONCLUSIONS
  This cross-sectional study relied on self-reported falls, mobility, and impairment status, which were not objectively verified.
  
  
  CONCLUSIONS
  Both CAF and activity restrictions related to CAF were common in people with MS and were reported by people who experienced falls and those who did not. The association of fall status with mobility function did not appear to be linear. Fall risk increased with declining mobility function; however, at a certain threshold, further declines in mobility function were associated with fewer falls, possibly because of reduced fall risk exposure.
authors.affiliation: Division of Physical Therapy, Department of Rehabilitation Medicine, University of Washington, Seattle, WA 98195, USA. pmatsuda@uw.edu
authors.forename: Patricia Noritake
authors.initials: PN
authors.lastname: Matsuda
authors.forename: Anne
authors.initials: A
authors.lastname: Shumway-Cook
authors.forename: Marcia A
authors.initials: MA
authors.lastname: Ciol
authors.forename: Charles H
authors.initials: CH
authors.lastname: Bombardier
authors.forename: Deborah A
authors.initials: DA
authors.lastname: Kartin
mesh_terms: D000058:Accidental Falls / Q000706:statistics & numerical data*; D000061:Accidents, Home / Q000706:statistics & numerical data; D000328:Adult; D016009:Chi-Square Distribution; D003430:Cross-Sectional Studies; D005239:Fear; D005260:Female; D006801:Humans; D008297:Male; D051346:Mobility Limitation; D009103:Multiple Sclerosis / Q000503:physiopathology* / Q000523:psychology*; D012307:Risk Factors; D012656:Self-Help Devices; D011795:Surveys and Questionnaires