To Örebro University

Objective: To evaluate the effects of a balance exercise program on falls in people with mild to moderate multiple sclerosis (MS).

Design: Multicenter, single-blinded, single-group, pretest-posttest trial.

Setting: Seven rehabilitation units within 5 county councils.

Participants: Community-dwelling adults with MS (NZ32) able to walk 100m but unable to maintain 30-second tandem stance with armsalongside the body.

Intervention: Seven weeks of twice-weekly, physiotherapist-led 60-minute sessions of group-based balance exercise targeting core stability, dualtasking, and sensory strategies (CoDuSe).

Main Outcome Measures: Primary outcomes: number of prospectively reported falls and proportion of participants classified as fallers during 7preintervention weeks, intervention period, and 7 postintervention weeks. Secondary outcomes: balance performance on the Berg Balance Scale,Four Square Step Test, sit-to-stand test, timed Up and Go test (alone and with cognitive component), and Functional Gait Assessment Scale;perceived limitations in walking on the 12-item MS Walking Scale; and balance confidence on the Activities-specific Balance Confidence Scalerated 7 weeks before intervention, directly after intervention, and 7 weeks later.

Results: Number of falls (166 to 43;P.001) and proportion of fallers (17/32 to 10/32;P.039) decreased significantly between thepreintervention and postintervention periods. Balance performance improved significantly. No significant differences were detected forperceived limitations in walking, balance confidence, the timed Up and Go test, or sit-to-stand test.

Conclusions: The CoDuSe program reduced falls and proportion of fallers and improved balance performance in people with mild to moderateMS but did not significantly alter perceived limitations in walking and balance confidence