History of fracture or sprain: new risk factors for falls in persons with multiple sclerosis
Mr Marc-Alexandre GUYOTa, Dr Agathe GRANDJEANa, Dr Hichem KHENIOUIa, Prof Patrick HAUTECOEURb, Dr Cécile DONZÉc
a Groupement Hospitalier de l'Institut Catholique de Lille - Médecine Physique et Réadaptation Fonctionnelle -, b Groupement Hospitalier de l'Institut Catholique de Lille - Neurologie, c Groupement Hospitalier de l'Institut Catholique de Lille - Médecine Physique et Réadaptation Fonctionnelle
To study the risk factors for falls in patients with multiple sclerosis (MS) presenting gait disturbances.
This is a retrospective review of prospectively collected data from a cohort of MS patients followed for gait disturbances between April 2013 and June 2014 in the neurological rehabilitation department. The history of falls, trauma, current treatments and clinical data (disease duration, clinical form, EDSS, motor skills, spasticity, pain) were collected. Univariate and multivariate analyzes were performed to predict the risk of falls.
196 patients (median EDSS: 6; age: 55 years (± 9.3)) were divided into 2 groups: fallers (n = 92), Non fallers (n = 103). In our model, taking antidepressants, previous fractures (upper limbs, spine), sprains of ankles and knees, impaired visual and brain functions (or mental) of EDSS were predictors of falls (AUC = 0.73; sensitivity = 0.74; specificity = 0.59).
Balance disorders and falls are among the most disabling symptoms of MS, affecting about 3/4 of patients during the course of the disease. In our study, 47.1% of patients had falled. These results are similar to those of Cattaneo et al, (54%) and of Finlayson et al, (52.2%). If visual disturbances and antidepressants have been identified as risk factors for falling, prior fracture and sprain were not included in those studies. This could explain the fear of falling in this population. Investigation of a history of fracture or sprain is recommended in the pervention of falls in MS patients with gait disturbances.
Cattaneo D, De Nuzzo C, Fascia T, Macalli M, Pisoni I, Cardini R. Risks of falls in subjects with multiple sclerosis. Arch Phys Med Rehabil 2002;83:864-7
Finlayson ML, Peterson EW, Cho CC. Risk factors for falling among people aged 45 to 90 years with multiple sclerosis. Arch Phys Med Rehabil 2006;87:1274-9
Keywords : multiple sclerosis, risk factor, fall