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Factors perceived as being related to accidental falls by persons with multiple sclerosis
Örebro University, School of Health and Medical Sciences.ORCID iD: 0000-0002-9760-3785
2009 (English)In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 31, no 16, p. 1301-1310Article in journal (Refereed) Published
Abstract [en]

Purpose. This study explores and describes factors that persons with multiple sclerosis (MS) perceive as being related to accidental falls. Method. A qualitative content analysis with primarily deductive approach was conducted using the International Classification of Functioning, Disability and Health. Twelve persons with MS, and identified as fallers, were interviewed. Results. Factors perceived to cause accidental falls that had not previously been targeted in MS populations in relation to falls were identified as divided attention, reduced muscular endurance, fatigue and heat sensitivity. Previously reported risk factors such as changed gait pattern, limited walking ability, impaired proprioception, vision and spasticity were supported. Activities involving walking, recreation and leisure, maintaining and changing body position, lifting or carrying, taking care of the home, washing the body, moving around, preparing meals and housekeeping were limited and considered to be risk activities. Supportive persons and assistive device reduced falls, and unsuitable physical environments and climate conditions induced falls. Several preventative strategies were described as partially compensating for the impairments, limitations and restrictions. Conclusions. Investigating accidental falls using the perspective of the patient gave important information about variables not earlier targeted in MS research.

Place, publisher, year, edition, pages
London: Taylor & Francis, 2009. Vol. 31, no 16, p. 1301-1310
Keywords [en]
Multiple sclerosis, accidental falls, international classification of functioning, disability and health, balance, qualitative content analysis
National Category
Medical and Health Sciences
Research subject
Medicine
Identifiers
URN: urn:nbn:se:oru:diva-3016DOI: 10.1080/09638280802532639ISI: 000268663000001PubMedID: 19479575Scopus ID: 2-s2.0-70449729791OAI: oai:DiVA.org:oru-3016DiVA, id: diva2:136350
Available from: 2008-10-15 Created: 2008-10-15 Last updated: 2017-12-14Bibliographically approved
In thesis
1. Walking ability, balance and accidental falls in persons with Multiple Sclerosis
Open this publication in new window or tab >>Walking ability, balance and accidental falls in persons with Multiple Sclerosis
2008 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

By using a pragmatic paradigm, different research methodologies were employed in this thesis. MS-related symptoms may be exaggerated due to heatsensitivity and it is supposed that cooling garments relieve the symptoms. The effects of wearing a Rehband® vest were evaluated in a sample of 42 persons with MS in a randomised controlled crossover study. Both objective and subjective statistically significant improvements were found when a cooled Rehband® vest was worn compared to the wearing of a room-tempered vest. Using a repeated-measures design, 10m and 30m timed walks and Timed Up and Go were studied in 42 persons with MS. Reproducibility was investigated within and between test points. High reproducibility was found both within (r=0.97–0.98) and between measure points (r=0.91–0.93). The correlation between the three tests was high (r=0.85). Differences at –23% to +40% were established as being needed to detect genuine changes. Severity of MS infl uenced the size of the differences, especially for the 30m timed walk test. The 12-item MS Walking Scale was translated and used in a cross-sectional study. Out of 81 persons with MS, 89–96% perceived limitations in standing or walking. The internal consistency of the scale was acceptable for nine items (0.69–0.84). The concurrent validity between the 12-item MS Walking Scale and the investigated objective tests was low: Berg Balance Scale (r=–0.368**), Four Square Step Test (r=0.338**) and Timed Up and Gocognitive (r=0.319*).

A prevalence of falling was found at 63% in a longitudinal cohort study with prospectively registered falls including 76 persons with MS. The odds of falling were fi ve fold when there was a reported need of using a walking aid indoors and outdoors and by 2.5 to 15.6 times while there was disturbed proprioception, depending on severity. The highest sensitivity was found for the Berg Balance Scale (94%) and the highest specifi city was found for the 12-item MS Walking Scale (82%). Positive predictive values at 70–83% were found for the Berg Balance Scale, Timed Up and Gocognitive, the Four Square Step Test and the 12-item MS Walking Scale. Finally, we explored and described factors that persons with MS perceive as related to accidental falls. A content analysis with a deductive approach was chosen. By conducting interviews, we found previously untargeted factors: divided attention, reduced muscular endurance, fatigue and heat-sensitivity. The content of the interviews also gave support to previously reported risk factors such as changes in gait pattern, walking disability, impaired proprioception and vision, and spasticity.

Place, publisher, year, edition, pages
Örebro: Örebro universitet, 2008. p. 94
Series
Örebro Studies in Medicine, ISSN 1652-4063 ; 21
Keywords
multiple sclerosis, cooling garment, gait, walking, balance, reliability, validity, accidental falls, prediction, ICF
National Category
Medical and Health Sciences
Research subject
Medicine
Identifiers
urn:nbn:se:oru:diva-2518 (URN)978-91-7668-631-7 (ISBN)
Public defence
2008-11-21, Wilandersalen, USÖ, M-huset, 701 85, Örebro, 09:00 (English)
Opponent
Supervisors
Available from: 2008-10-15 Created: 2008-10-15 Last updated: 2017-10-18Bibliographically approved

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Nilsagård, YlvaGunnarsson, Lars-Gunnar

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