A Prospective Evaluation of Balance, Gait, and Strength to Predict Falling in Women With Multiple Sclerosis

Objective: To identify measures of balance, gait, and strength that predict falls in women with multiple sclerosis (MS). Design: This prospective study followed participants for I year. Setting: University research laboratories. Participants: A convenience sample of women with MS (N=99). Interventions: Not applicable. Main Outcome Measures: Balance was assessed with the limits of stability (LOS) test and the Sensory Organization Test. Peak force, torque, and power of knee flexors and extensors as well as hip abductors and adductors were also measured. Temporal-spatial parameters of gait were measured by an instrumented walkway system. For 1 year after baseline assessments, the participants reported their falls. Participants were then classified based on the number of reported falls for use in logistic regression models to predict either people with at least 1 fall or people with at least 2 falls (recurrent fallers). Results: A total of 159 falls were reported by 48% of the participants. Expanded Disability Status Scale scores, leaning forward to the LOS, and standing sway within a visually referenced surround significantly predicted people with at least 1 fall as well as recurrent fallers. Stance-phase asymmetries and base-of-support width during gait, as well as the force and power produced during leg extension or flexion additionally predicted recurrent fallers. The models' overall predictive accuracy ranged from 69% to 85%. Conclusions: This prospective study confirmed the prevalence and multifactorial nature of falls in this MS sample. In addition to advancing disease status, impaired forward LOS and visually dependent sway (as well as gait asymmetries and leg flexor-extensor weakness for recurrent fallers) predict future falls in women with MS.