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Interventions for preventing falls in people with multiple sclerosis.

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Falls interventions for multiple sclerosis (MS) show uncertain effectiveness, with exercise potentially improving balance and mobility. More robust trials are needed to establish evidence-based guidelines for falls prevention in MS patients.

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Area of Science:

  • Neurology
  • Rehabilitation Science
  • Public Health

Background:

  • Multiple sclerosis (MS) is a prevalent central nervous system disease affecting 2.3 million worldwide.
  • High fall rates (56%) are reported in people with MS, yet clinical guidelines lack evidence-based falls interventions.
  • There is a need to synthesize information on the effectiveness of falls prevention interventions specifically for MS.

Purpose of the Study:

  • To evaluate the effectiveness of interventions designed to reduce falls in people with MS.
  • To compare falls prevention interventions against control groups.
  • To compare different types of falls prevention interventions against each other.

Main Methods:

  • Systematic review and meta-analysis of randomized controlled trials (RCTs) and quasi-RCTs.
  • Searched multiple databases including Cochrane, PubMed, Embase, CINAHL, and PsycINFO up to September 2018.
  • Included 13 trials with 839 participants; analyzed falls rate, risk of falling, number of falls, and adverse events.

Main Results:

  • Evidence for exercise interventions versus control on falls rate and number of fallers was uncertain (very low to low-quality evidence).
  • Most comparisons between falls interventions and controls showed no significant effect.
  • Exercise interventions showed potential benefits for balance function (SMD 0.50) and mobility (SMD 16.30 self-reported, 0.28 objective), but these secondary outcomes require cautious interpretation.

Conclusions:

  • The evidence for falls prevention interventions in MS is sparse and uncertain, with mixed risk of bias and low-quality evidence.
  • Exercise interventions may improve balance and mobility, but further research is needed.
  • Robust RCTs are required to investigate the effectiveness of multifactorial falls interventions in people with MS.