Evaluation of a Self-management Program to Prevent Falls in Ambulatory and Non-ambulatory People With Multiple Sclerosis

Purpose and aims The overall purpose is to evaluate an online fall prevention programme for ambulatory and non-ambulatory people with multiple sclerosis (PwMS). The programme incorporates key features of self-management and addresses a variety of fall risk factors. The effects of the programme in decreasing number of falls will be evaluated in a full scale randomised controlled trial (RCT). The hypothesis is that after participating in the programme, PwMS will identify and self-manage risk factors for falls in their everyday life while taking the daily fluctuations of multiple sclerosis (MS) into consideration (i.e., develop fall prevention behaviours), and thereby reduce the number of falls.

Aims:

1. To determine if the fall prevention programme is effective in reducing falls in PwMS 6 and 12 months after start of intervention.
2. To determine if the program has an effect on secondary outcomes at 3, 6 and 12 months.
3. To explore how process evaluation components (context, implementation, mechanisms of impact) inform interpretation of outcomes.
4. To evaluate the cost effectiveness of the fall prevention program at 12 months after start of intervention.

INTRODUCTION MS is a chronic inflammatory, demyelinating, and neurodegenerative disease with a global prevalence of about 36 per 100,000 population. The prevalence in women is two to four times higher than in men and the usual onset is between 20 and 40 years of age. The disease is typically progressive in nature with consequences that include an increased risk for falls. Up to 71% of PwMS fall each six months (1). Those who report a fall in the past year have an 82% probability of falling again in the six months after a fall and a 56% probability of sustaining an injurious fall (1). Falls among PwMS are associated with injuries, fear of falling and low health-related quality of life (2).

Several consequences of MS are known fall risk factors for this population, including impaired balance, reduced walking speed, and impaired cognition (2). The lack of attention given to behavioural and environmental influences on fall risk for PwMS is a major gap in existing evidence. Another major gap in MS falls research is that few studies have explored influences on fall risk among individuals who are non-ambulatory, i.e., only capable of walking a few steps or not at all (3). Furthermore, most interventions aiming to prevent falls among PwMS have excluded non-ambulatory individuals. To date, only two research teams are addressing the fall prevention needs of non-ambulatory PwMS: ours and a team based in the U.S. (4). The importance of targeting a variety of modifiable risk factors through fall prevention programs for PwMS has been highlighted (5). The need for comprehensive approaches to fall prevention that address physical, environmental, and behavioural aspects of falls management has been echoed by Gunn et al (6). Despite the recognition of the value of attention to diverse influences on fall risk, most fall prevention interventions for PwMS focus only on addressing physical impairments, such as compromised balance.