Anna Carling

Activities-Specific Balance Confidence in People with Multiple Sclerosis

Objective. To evaluate the validity of the Activities-specific Balance Confidence scale (ABC) in people with multiple sclerosis (PwMS). Design. A multicentre, cross-sectional study. Setting. Six rural and urban Swedish sites, including specialized units at hospitals and primary care centers. Participants. A sample of 84 PwMS with subjective gait and balance impairment but still able to walk 100 m (comparable with EDSS 1–6). Outcome Measures. Timed Up and Go, Timed Up and Gocog, 25-foot Timed Walk Test, Four Square Step Test, Dynamic Gait Index, Chair Stand Test, 12-item MS Walking Scale, self-reported falls, and use of assistive walking device were used for validation. Results. The concurrent convergent validity was moderate to good (0.50 to −0.75) with the highest correlation found for the 12-item MS Walking Scale. The ABC discriminated between multiple fallers and nonfallers but not between men and women. Ecological validity is suggested since ABC discriminated between users of assistive walking device and nonusers. The internal consistency was high at α = 0.95, and interitem correlations were between 0.30 and 0.83. Conclusion. This study supports the validity of the ABC for persons with mild-to-moderate MS. The participants lacked balance confidence in many everyday activities, likely restricting their participation in society.

CoDuSe group exercise programme improves balance and reduces falls in people with multiple sclerosis: A multi-centre, randomized, controlled pilot study:

Background: Imbalance leading to falls is common in people with multiple sclerosis (PwMS). Objective: To evaluate the effects of a balance group exercise programme (CoDuSe) on balance and walking in PwMS (Expanded Disability Status Scale, 4.0–7.5). Methods: A multi-centre, randomized, controlled single-blinded pilot study with random allocation to early or late start of exercise, with the latter group serving as control group for the physical function measures. In total, 14 supervised 60-minute exercise sessions were delivered over 7 weeks. Pretest–posttest analyses were conducted for self-reported near falls and falls in the group starting late. Primary outcome was Berg Balance Scale (BBS). A total of 51 participants were initially enrolled; three were lost to follow-up. Results: Post-intervention, the exercise group showed statistically significant improvement (p = 0.015) in BBS and borderline significant improvement in MS Walking Scale (p = 0.051), both with large effect sizes (3.66; −2.89). No other significant differences were found between groups. In the group starting late, numbers of falls and near falls were statistically significantly reduced after exercise compared to before (p < 0.001; p < 0.004). Conclusion: This pilot study suggests that the CoDuSe exercise improved balance and reduced perceived walking limitations, compared to no exercise. The intervention reduced falls and near falls frequency.

Falls in people with multiple sclerosis: experiences of 115 fall situations:

Objectives: The aim was to describe falls and the perceived causes, experienced by people with multiple sclerosis shortly after falling. Design: A qualitative study using content analysis and quantitative data to illustrate where and why people report falls most commonly. Semi-structured telephone interviews were performed. Interviews were conducted shortly (0–10 days) after a fall. Subjects: In all, 67 informants who had reported at least one fall during the previous three-month period and who used a walking aid participated. Results: A total of 57 (85%) informants fell at least once during eight months resulting in 115 falls; 90 (78%) falls happened indoors, most commonly in the kitchen (n = 20; 17%) or bathroom (n = 16; 14%). Informants fell during everyday activities and walking aids had been used in more than a third of the reported falls. The falls were influenced of both intrinsic and extrinsic factors. Two categories emerged from the analysis: ‘activities when falling’ and ‘influencing factors’. The category contained three (basic activities of daily living, instrumental activities of daily living and leisure and work) and six (multiple sclerosis–related symptoms, fluctuating body symptoms, being distracted, losing body control, challenging surrounding and involvement of walking aid) subcategories, respectively. Conclusion: The majority of falls occurs indoors and in daily activities. Several factors interacted in fall situations and should be monitored and considered to reduce the gap between the person’s capacity and the environmental demands that cause fall risk. Fluctuation of bodily symptoms between and within a day is a variable not earlier targeted in multiple sclerosis fall risk research.

Making it work: experience of living with a person who falls due to multiple sclerosis

Abstract Purpose: The purpose of this study was to describe how everyday life is experienced by next of kin sharing residence with a person who falls due to multiple sclerosis (MS). Methods: Twenty face-to-face interviews were analysed using a qualitative content analysis. Results: The overall theme “Making it work” represents the next of kin’s struggle to make life work. It comprises three themes: “Taking responsibility”, “Making adjustments”, and “Standing aside for someone else”. The two first themes reflect what relatives do to make the situation work, and the last theme represents what they give up. Conclusion: Next of kin who share residence and everyday life with a person with MS are affected by that person’s occasional falls. They often take on the responsibility of preventing such falls and adapt their lives practically and emotionally. However, adaptation is neither always enough or always possible. In these cases, relatives often deprioritize their own needs and free time to make everyday life in the home work. Implications for rehabilitation By highlighting that next of kin also are affected by the falls of their cohabiting person with multiple sclerosis enhances the importance of fall prevention activities that should include the next of kin. Next of kin to people who occasionally fall due to multiple sclerosis can be in need of both practical and emotional support from the health care system. Enhanced information from the health care system can empower and help them to take care of themselves while managing to live with, care for, and protect the person with multiple sclerosis from falls.

Comparison of trunk impairment scale versions 1.0 and 2.0 in people with multiple sclerosis : A validation study

ABSTRACT Background: Trunk control impairment often accompanies multiple sclerosis (MS). Trunk stability is necessary for movements of extremities, as are selective trunk movements for normal gait. Measuring trunk function is thus of interest. Methods: We examined the relationships between the Trunk Impairment Scale (TIS1.0 and TIS2.0) and the Berg Balance Scale (BBS), 5 sit-to-stand test (5STS), Timed Up and Go test (TUG), 10-m timed walk test (10TW), 2-min walk test (2MWT), Falls Efficacy Scale – International, and 12-item MS Walking Scale (MSWS-12) in 47 outpatients. We determined construct validity by calculating the degree to which the TIS versions produced different scores between known groups: use or nonuse of walking aid, MS disability status, and whether participants experienced a fall or not during 14 weeks. Results: TIS correlated moderately with BBS and 5STS; moderately (TIS1.0) or weakly (TIS2.0) with TUG, 10TW, and 2MWT; and weakly to moderately with MSWS-12 in subgroups with Expanded Disability Status Scale (EDSS) >6.0. No other clear correlation patterns were found. TIS did not discriminate between known groups. Conclusions: TIS1.0 is recommended for individuals with MS (EDSS score 4.0–7.5). Better trunk function correlates with better balance and walking ability. TIS has limited value in fall risk screening.

The validity of the 5 and 10 sit-to-stand test

Background: To rise from a sitting to a standing position and to sit down again are categorized as basic transitional movements, and are performed approximately 50 times a day. The sit-to-stand test (STS test) evaluates strength in lower extremities, neuromuscular functions, balance and vestibular function. There are several versions of the test; two examples of these are the 5STS and 10STS tests. For people with multiple sclerosis (MS), only the 5STS test has been validated. A potential difference between the 5STS and 10STS test can be that more repetitions require more muscular endurance and, thus, the 10STS test will reveal impaired muscular endurance more than the 5STS test.Aim: The aim was to evaluate the validity for the 5STS and 10STS tests for people with moderate MS.Methods: Forty-seven people with MS with a limited ( 20 m) walking ability were included (32 women; 30 secondary and 12 primary progressive MS). The STS tests were slightly modified for safety reasons; instead of crossing arms over the chest, hand support was allowed. Time was taken from the starting position sitting using the command ‘Go’ and stopped when the participant sat down again after completing the 10th standing position. An intermediate time was taken when sitting down after the fifth standing position (5STS test). Validity was evaluated using the timed up and go test (TUG), 10 minute walk test (10MWT), 2 minute walk test (2MWT) and the Berg balance scale (BBS); calculated using Spearman’s rank correlation. Correlations exceeding 0.60 were considered strong.Results: Strong correlations (r=0.60–0.70) were found between the 5STS and 10STS test and the TUG, the 10 MWT, the 2MWT and the BBS. The correlation between the 5STS and 10STS test (r=0.86) indicates that the tests measure slightly different abilities. A slightly stronger correlation was found between the 5STS and BBS (r=−0.68) compared to the 10STS and BBS (r=−0.61). The correlations were stronger between the 10STS and the walk tests compared to the 5STS and walk tests. The high correlation between the 10STS and the 2MWT (r=0.70) can possibly be explained by a muscular endurance component.Conclusion: Both the 5STS and 10STS test are valid for people with moderate MS but they do not measure the exact same abilityBackground: Many people with multiple sclerosis (MS) have increased postural sway, which is associated with a higher risk of falls. Significantly increased sway has been found in people with slight ...