Abstract
Date Presented 4/7/2016
This paper describes a study of the prevalence of self-reported injurious falls and trends in fall prevention strategy use among people with multiple sclerosis (MS). Findings and associated implications for occupational therapy assessment and intervention targeting people with MS are highlighted.
Primary Author and Speaker: Elizabeth Peterson
Contributing Authors: Miho Asano, Michelle Cameron, Marcia Finlayson
PURPOSE: To investigate the prevalence of self-reported injurious falls and trends in fall prevention strategy use among people with multiple sclerosis (PwMS) over a 24-mo period.
RATIONALE: Falls among PwMS are common and often injurious (Peterson, Cho, von Koch, & Finlayson, 2008; Cameron, Thielman, Mazumder, & Bourdette, 2013). Identifying PwMS at high risk for injurious falls, providing interventions at an intensity appropriate to risk level, and understanding patterns of prevention behaviors can support cost-effective prevention of fall-related injuries.
DESIGN: Prospective cohort study using data collected at baseline, 12 mo, and 24 mo.
PARTICIPANTS: PwMS (N = 58) of any subtype, ages 18 to 50 yr, with Expanded Disability Status Scale score ≤ 6.0, recruited from MS clinics at the Portland Veterans Affairs Medical Center and Oregon Health and Science University and from the surrounding areas
METHOD: Measures included self-reported injurious falls in the past year reported and scores on the Fall Prevention Strategies Survey (FPSS; Finlayson, Peterson, Fujimoto, & Plow, 2009).
ANALYSIS: Characteristics of participants, data on injurious falls, and FPSS data over the study period were analyzed descriptively. SPSS version 22 was used for all analyses.
FINDINGS: A total of 43 participants completed the study. Prevalence of self-reported injurious falls was 40%, 35%, and 16% respectively at each time point. Seventy-one percent of participants reporting injurious falls at baseline (12 of 17) also reported injurious falls at 12 and/or 24 mo. Findings showed patterns of injurious fall experiences and fall prevention strategy use varied among participants reporting injurious falls at baseline and also at 12 and/or 24 mo; participants reporting no injurious falls over the 24 mo (n = 18); and new injurious fallers (n = 8) reporting no falls at baseline.
FPSS scores for each participant group improved at 24 mo compared with baseline.
DISCUSSION: Subgroup analyses yielded insights into sources of variation in injurious fall rates. Findings point to the potential value of using (1) self-reported history of injurious falls to predict future injurious falls and (2) brief interventions to motivate engagement in fall prevention behaviors.
Although our study was not intended as an intervention study, findings suggest the potential value of brief interventions to foster adaptive fall prevention behaviors among PwMS. We provided the FPSS to participants 3 times over the 24-mo study period and observed FPSS scores for each participant group that were higher at 24 mo compared with baseline. The number of fall prevention strategies used by baseline injurious fallers and noninjurious fallers was also higher at 24 mo compared with baseline. It is possible that exposure to the FPSS motivated study participants to use fall prevention behaviors and that those behaviors may have contributed to the decline in the prevalence of injurious falls observed. Additional studies are needed to confirm these hypotheses.
IMPACT STATEMENT: Findings influence occupational therapy by suggesting the potential value of using history of injurious falls to identify PwMS at risk for future injurious falls and using brief interventions to foster adaptive fall prevention behaviors among PwMS.
References:
Cameron, M., Thielman, E., Mazumder, R., & Bourdette, D. (2013). Predicting falls in people with multiple sclerosis: Fall history is as accurate as more complex measures. Multiple Sclerosis International, 2013, 496325. http://dx.doi.org/10.1155/2013/496325
Finlayson, M., Peterson, E., Fujimoto, K., & Plow, M. (2009). Rasch validation of the falls prevention strategies survey. Archives of Physical Medicine and Rehabilitation, 90, 2039–2046. http://dx.doi.org/10.1016/j.apmr.2009.07.013
Peterson, E., Cho, C., von Koch, L., & Finlayson, M. (2008). Injurious falls among middle aged and older adults with multiple sclerosis. Archives of Physical Medicine and Rehabilitation, 89, 1031–1037. http://dx.doi.org/10.1016/j.apmr.2007.10.043
