Falls, fear of falling and falls self-efficacy among adults with multiple sclerosis

Although falls are a major cause of morbidity and mortality among older adults and increasingly recognized as threat to the wellbeing of people living with chronic neurological conditions, fall prevention research involving people with multiple sclerosis (MS) is just emerging. The overall aim of this thesis was to generate new knowledge about fear of falling (FoF), fall-related injuries, and falls self-efficacy among middle aged and older adults with MS to inform development of occupational therapy interventions. Two studies used cross-sectional data from telephone interviews with people with MS. In Study I, logistic regression models were used to identify factors associated with increased likelihood of reporting FoF among people with MS and factors associated with activity curtailment among the subset of individuals reporting FoF.

The aim of Study II was to determine the prevalence of, and risk factors for, receiving medical attention for a recent injurious fall among middle-aged and older adults who have MS. Study III aimed to determine the outcomes of a pilot study of a falls risk management program designed specifically for people with MS and the appropriateness of several outcome tools for capturing expected changes. A pre/post intervention design was utilized and telephone interviews were used to gather baseline and post-intervention data. Study IV was a phenomenological study undertaken to describe the lived experience of falls self-efficacy in everyday activities among six people with MS. Data were collected via semi-structured interviews and analyzed using the empirical, phenomenological, and psychological method.

The vast majority of the people participating in Studies I-IV lived in the community. Study I findings indicated that 63.5% of the participants reported FoF. Increased likelihood of reporting FoF was associated with being female, experiencing greater MS symptom interference during everyday activities, history of a fall in the past 6 months, and using a walking aid. Among participants reporting FoF, 82.6% reported curtailing activity. Increased likelihood of activity curtailment among people reporting FoF was associated with using a walking aid, needing moderate or maximum assistance with instrumental activities of daily living, and having less than excellent self-reported mental health. In Study II, more than 50% of participants reported injurious falls; 12%, in the 6 months before the interview. Compared with participants receiving medical attention for a fall-related injury > 6 months ago or never, participants who received medical attention for a fall-related injury within the past 6 months were more likely to report FoF and osteoporosis. In Study III, significant improvements were observed for participants attending >5:6 program sessions as well as participants attending < 4 sessions, although some instruments, including the Falls Efficacy Scale, exhibited poor internal consistency. The Fall Prevention Strategies Survey, which was developed as part of Study III, yielded valuable information regarding adaptive changes in participants' fall risk management behaviors. In Study IV, one main theme (falls self-efficacy: supporting ability to stay active and involved in life) and six subthemes were reflected in participants' lived experiences: understanding personal MS symptoms and fall risk; owning the changed body; focusing on what you can control; learning as you go; having heightened awareness while doing; and taking action.

In conclusion, this thesis makes a useful contribution to clinical practice by describing the pervasive nature of FoF and fall-related injuries among people with MS and suggesting approaches to assessment and intervention that have the potential to address the specific fall prevention needs of people with MS. Findings from this thesis are relevant to occupational therapists and other professionals who seek to support people with MS in their efforts to manage fall risk and live life to its fullest.

List of scientific papers

I. Peterson EW, Cho CC, Finlayson ML (2007). Fear of falling and associated activity curtailment among middle aged and older adults with multiple sclerosis. Mult Scler. 13(9): 1168-75.
https://pubmed.ncbi.nlm.nih.gov/17881391

II. Peterson EW, Cho CC, von Koch L, Finlayson ML (2008). Injurious falls among middle aged and older adults with multiple sclerosis. Arch Phys Med Rehabil. 89(6): 1031-7.
https://pubmed.ncbi.nlm.nih.gov/18503796

III. Finlayson M, Peterson E, Cho C (2009). Findings of a pilot study exploring the potential of a fall risk management program for middle aged and older adults with multiple sclerosis. NeuroRehabilitation. [Accepted]
https://pubmed.ncbi.nlm.nih.gov/19822941

IV. Peterson E, Kielhofner G, Tham K, von Koch L (2009). Falls self-efficacy among adults with multiple sclerosis: a phenomenological study. [Submitted]