title: Multiple sclerosis severity and concern about falling: Physical, cognitive and psychological mediating factors.
abstract: BACKGROUND
  Concern about falling can have devastating physical and psychological consequences in people with multiple sclerosis (MS). However, little is known about physical and cognitive determinants for increased concern about falling inthis group.
  
  
  OBJECTIVE
  To investigate direct and indirect relationships between MS severity and concern about falling using structural equation modelling (SEM).
  
  
  METHODS
  Two hundred and ten community-dwelling people (21-73 years) with MS Disease Steps 0-5 completed several physical, cognitive and psychological assessments. Concern about falling was assessed using the Falls Efficacy Scale-International.
  
  
  RESULTS
  Concern about falling was significantly associated with MS Disease Step and also balance, muscle strength, disability, previous falls, and executive functioning. SEM revealed a strong direct path between MS Disease Step and concern about falling (r = 0.31, p <  0.01), as well as indirect paths explained by impaired physical ability (r = 0.25, p <  0.01) and reduced cognitive function (r = 0.13, p <  0.01). The final model explained 51% of the variance of concern about falling in people with MS and had an excellent goodness-of-fit.
  
  
  CONCLUSIONS
  The relationship between MS severity and increased concern about falling was primarily mediated by reduced physical ability (especially if this resulted in disability and falls) and less so by executive functioning. This suggests people with MS have a realistic appraisal of their concern about falling.
authors.affiliation: Neuroscience Research Australia, University of New South Wales, Sydney, NSW, Australia.|Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
authors.forename: Rob
authors.initials: R
authors.lastname: van Vliet
authors.affiliation: Neuroscience Research Australia, University of New South Wales, Sydney, NSW, Australia.
authors.forename: Phu
authors.initials: P
authors.lastname: Hoang
authors.affiliation: Neuroscience Research Australia, University of New South Wales, Sydney, NSW, Australia.
authors.forename: Stephen
authors.initials: S
authors.lastname: Lord
authors.affiliation: Neuroscience Research Australia, University of New South Wales, Sydney, NSW, Australia.
authors.forename: Simon
authors.initials: S
authors.lastname: Gandevia
authors.affiliation: Neuroscience Research Australia, University of New South Wales, Sydney, NSW, Australia.
authors.forename: Kim
authors.initials: K
authors.lastname: Delbaere
mesh_terms: D000058:Accidental Falls; D000328:Adult; D000368:Aged; D003071:Cognition; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000175:diagnosis / Q000503:physiopathology* / Q000523:psychology; D053580:Muscle Strength; D004856:Postural Balance
keywords: Accidental falls; activity avoidance; anxiety; depression; disease progression; multiple sclerosis