title: A systematic review of factors associated with accidental falls in people with multiple sclerosis: a meta-analytic approach.
abstract: OBJECTIVE
  To determine whether there are demographic, clinical, and instrumental variables useful to detect fall status of patients with multiple sclerosis.
  
  
  METHODS
  PubMed and the Cochrane Library.
  
  
  METHODS
  Eligible studies were identified by two independent investigators. Only studies having a clear distinction between fallers and non-fallers were included and meta-analysed. Odds ratios (ORs) and standard mean differences (SMDs) were calculated and pooled using fixed effect models.
  
  
  RESULTS
  Among 115 screened articles, 15 fulfilled criteria for meta-analyses, with a total of 2425 patients included. Proportion of fallers may vary from 30% to 63% in a time frame from 1 to 12 months. No significant publication bias was found, even though 12/15 studies relied on retrospective reports of falls, thus introducing recall biases. Risk factors for falls varied across studies, owing to heterogeneity of populations included and clinical instruments used. The meta-analytic approach found that, compared with non-fallers, fallers had longer disease duration (SMD = 0.14, p = 0.02), progressive course of disease (OR = 2.02, p < 0.0001), assistive device for walking (OR = 3.16, p < 0.0001), greater overall disability level (SMD = 0.74, p < 0.0001), slower walking speed (SMD = 0.45, p = 0.0005), and worse performances in balance tests (Berg Balance Scale: SMD = -0.48, p = 0.002; Timed up-and-go test, SMD = 0.31, p = 0.04), and force-platform measures (postural sway) with eyes opened (SMD = 0.71, p = 0.006) and closed (SMD = 0.83, p = 0.01), respectively.
  
  
  CONCLUSIONS
  Elucidations regarding risk factors for accidental falls in patients with multiple sclerosis (PwMs) are provided here, with worse disability score, progressive course, use of walking aid, and poorer performances in static and dynamic balance tests strongly associated with fall status.
authors.affiliation: Department of Neurology and Psychiatry, Sapienza University, Rome, Italy.
authors.forename: Costanza
authors.initials: C
authors.lastname: Giannì
authors.affiliation: Department of Neurology and Psychiatry, Sapienza University, Rome, Italy luca.prosperini@uniroma1.it.
authors.forename: Luca
authors.initials: L
authors.lastname: Prosperini
authors.affiliation: LaRiCE: Gait and Balance Disorders Laboratory, Don Gnocchi Foundation I.R.C.C.S, Italy.
authors.forename: Johanna
authors.initials: J
authors.lastname: Jonsdottir
authors.affiliation: LaRiCE: Gait and Balance Disorders Laboratory, Don Gnocchi Foundation I.R.C.C.S, Italy.
authors.forename: Davide
authors.initials: D
authors.lastname: Cattaneo
mesh_terms: D000058:Accidental Falls; D006801:Humans; D009103:Multiple Sclerosis / Q000150:complications* / Q000503:physiopathology; D004856:Postural Balance; D012307:Risk Factors
keywords: Accidental falls; disability; imbalance; meta-analysis; multiple sclerosis; systematic review