title: Utility of disease-specific measures and clinical balance tests in prediction of falls in persons with multiple sclerosis.
abstract: OBJECTIVE
  The sensory and motor deficits associated with multiple sclerosis (MS) contribute to falls with the majority of persons with MS falling at least once annually. To appropriately direct treatment, accurate fall prediction measures are needed. In this study of community-dwelling individuals with MS followed for 12 months, we sought to determine frequency of falls, utility of clinical balance tests to predict falls, and accuracy of participants' retrospective recall of fall events.
  
  
  METHODS
  Independently ambulatory persons with MS underwent 5 clinical balance tests including Activities-specific Balance Confidence, Berg Balance Scale, Functional Reach, Timed Up and Go, and Dynamic Gait Index, and one disease-specific measure of disability (Expanded Disability Status Scale) and then were followed for 1 year. Participants were queried monthly by phone to determine the number of fall events that had occurred. Accuracy of fall prediction was determined by receiver operating characteristic curve analysis and comparison of balance test performance between fallers and nonfallers.
  
  
  RESULTS
  Sixty-one percent of the 38 participants were classified as fallers at 12-month follow-up. Only the Berg Balance Scale, Dynamic Gait Index, and the Activities-specific Balance Confidence demonstrated clinically useful levels of accuracy. In addition, participants were generally poor in their accurate recall of fall events relative to their monthly fall reports.
  
  
  CONCLUSIONS
  The majority of participants fell during a 1-year prospective follow-up. Only 2 balance performance measures and 1 balance confidence measure accurately distinguished between fallers and nonfallers as well as possessed clinically useful levels of sensitivity and specificity. These results also emphasized the inaccuracy of retrospective fall history in an MS sample.
authors.affiliation: University of Utah Department of Physical Therapy, Salt Lake City, UT 84124, USA. Lee.Dibble@hsc.utah.edu
authors.forename: Leland E
authors.initials: LE
authors.lastname: Dibble
authors.forename: Cielita
authors.initials: C
authors.lastname: Lopez-Lennon
authors.forename: Warren
authors.initials: W
authors.lastname: Lake
authors.forename: Carrie
authors.initials: C
authors.lastname: Hoffmeister
authors.forename: Eduard
authors.initials: E
authors.lastname: Gappmaier
mesh_terms: D000058:Accidental Falls; D000328:Adult; D004185:Disability Evaluation; D005260:Female; D005684:Gait / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000503:physiopathology*; D004856:Postural Balance / Q000502:physiology*; D012189:Retrospective Studies; D012307:Risk Factors