Examination of Risk Factors Associated With Falls and Injurious Falls in People With Multiple Sclerosis: An Updated Nationwide Study

Objective: To provide an update on risk factors associated with falls and injurious falls among people with multiple sclerosis (PwMS) in the United States. Design: Nationwide cross-sectional web -based survey. Setting: Community setting. Participants: Adult PwMS (n=965). Interventions: Not applicable. Main Outcome Measures: Participants completed self -report surveys of demographics, clinical data, concerns about falling, occurrence of falls, factors associated with falls, and injurious falls in the past 6 months. Participants also completed Patient -Reported Outcomes Measurement Information System (PROMIS) measures of depression, pain interference, and physical function, and the Fatigue Severity Scale. Results: The most common self -reported factors associated with falls included personal factors such as poor balance (75%), muscle weakness (54%), and/or fatigue (35%), environmental factors such as general surface conditions (37%) and/or distraction (15%), and activities -related factors such as urgency to complete a task (35%) and/or multitasking (27%). Logistic regression analyses indicated that higher fatigue severity (OR=1.19, P <.01) and higher pain interference (OR=1.02, P <.01) were associated with higher odds of experiencing at least 1 fall. Any level of concern, even minimal concern about falling was also significantly associated with a higher odd of experiencing at least 1 fall (ORs range 2.783.95, all P <.01). Fair to very high concerns about falling compared with no concern about falling (ORs range=5.17 - 10.26, all P <.05) was significantly associated with higher odds of sustaining an injurious fall. Conclusions: Findings suggest falls prevention approaches in PwMS should be multifactorial and include personal, environmental, and activitiesrelated factors. Particular attention on fatigue, pain, and concern about falling may be needed to reduce incidence of falls and injurious falls in this population.