title: Identification of risk factors for falls in multiple sclerosis: a systematic review and meta-analysis.
abstract: BACKGROUND
  Falls are a significant issue in people with multiple sclerosis (MS), with research demonstrating fall rates of more than 50%.
  
  
  OBJECTIVE
  The purpose of this study was to evaluate the risk factors associated with falling in people with MS.
  
  
  METHODS
  Mixed search methods were used, including computer-based and manual searches. Additionally, hand searches of reference lists and conference abstracts were performed. All literature published from the source's earliest date to January 2012 was included; only full-text English-language sources (or those where a translation was available) were included.
  
  
  METHODS
  Eligibility criteria specified articles evaluating any aspect of fall risk in adults with a confirmed MS diagnosis, where the incidence of falling as determined by prospective or retrospective participant report was included.
  
  
  METHODS
  Data were extracted independently by 2 reviewers using a written protocol and standardized extraction documentation. Detailed assessment of each article was independently undertaken by both reviewers, including assessment of study quality using an adaptation of the Newcastle Ottawa Scale plus extraction of key data (participant characteristics, fall incidence, and outcomes).
  
  
  RESULTS
  The final review comprised 8 articles with a total of 1,929 participants; 1,037 (53.75%) were classified as fallers. Eighteen different risk factors were assessed within the included studies. Meta-analysis demonstrated an increase in fall risk associated with impairments of balance and cognition, progressive MS, and use of a mobility aid. Narrative review of the qualitative articles and those factors where meta-analysis was not possible also was undertaken.
  
  
  CONCLUSIONS
  Variation in assessment, analysis, and reporting methods allowed meta-analysis for only 4 factors.
  
  
  CONCLUSIONS
  There is limited evidence of the factors associated with fall risk in people with MS. Further methodologically robust studies are needed.
authors.affiliation: School of Health Professions, Plymouth University, Plymouth, UK.
authors.forename: Hilary J
authors.initials: HJ
authors.lastname: Gunn
authors.forename: Paul
authors.initials: P
authors.lastname: Newell
authors.forename: Bernhard
authors.initials: B
authors.lastname: Haas
authors.forename: Jonathan F
authors.initials: JF
authors.lastname: Marsden
authors.forename: Jennifer A
authors.initials: JA
authors.lastname: Freeman
mesh_terms: D000058:Accidental Falls / Q000706:statistics & numerical data*; D000328:Adult; D006801:Humans; D009103:Multiple Sclerosis / Q000150:complications / Q000503:physiopathology*; D018570:Risk Assessment; D012307:Risk Factors