Fall Risk Reduction in Multiple Sclerosis: Exercise Versus Behavior
Condition: Multiple Sclerosis; Adult Disease
MeSH terms: Multiple Sclerosis; Sclerosis
Study type: Interventional
Phase: Phase 1/Phase 2

Summary: 
      Falls are a serious health concern for persons with multiple sclerosis (MS). Over 50% of
      persons with MS suffer a fall over a 6-month periodwith the majority of falls resulting in
      medical attention for injuries (i.e., lacerations, bone fractures, & head injuries). The
      effects of a fall are often compounded as it can lead to activity curtailment, physiological
      deconditioning, and institutionalization. Despite the importance of falls in persons with MS,
      the appropriate prevention strategies (i.e. rehabilitation approaches) are not clear. The
      purpose of this investigation is to determine whether exercise based or educational based
      interventions are more suited for fall prevention in older adults with MS.
    

Detailed description: 
      Falls are a serious health concern for persons with multiple sclerosis (MS). Over 50% of
      persons with MS suffer a fall over a 6-month periodwith the majority of falls resulting in
      medical attention for injuries (i.e., lacerations, bone fractures, & head injuries). The
      effects of a fall are often compounded as it can lead to activity curtailment, physiological
      deconditioning, and institutionalization. Despite the importance of falls in persons with MS,
      the appropriate prevention strategies (i.e. rehabilitation approaches) are not clear.

      It is well known that causes of falls are multifactorial with over 400 risk factors
      identified. However, it is believed that these factors can be divided into two main classes:
      intrinsic (e.g. physiological factors) and extrinsic factors. For instance balance
      dysfunction, spasticity and muscle weakness are physiological risk factors for falls in MS .
      Behavioral fall risk factors in MS include choosing appropriate footwear, lighting and
      utilizing appropriate assistive device. There is evidence that both types of risk factors can
      be minimized with appropriately designed interventions in persons with MS and have been shown
      to reduce fall risk and incidence in other clinical populations. This has led to calls for
      the combination of exercise training program that targets specific, modifiable physiological
      risk factors and educational interventions targeting modifiable behavioral risk factors in
      persons with MS. However, there is minimal evidence that these interventions in isolation or
      combination actually reduce fall incidence or risk in persons with MS. This proposal seeks to
      determine the effectiveness of a combined exercise and educational rehabilitation strategy to
      prevent falls in persons with MS.
    

Intervention name(s): Home-based exercise; Education; Exercise plus Education
Intervention type(s): Behavioral; Behavioral; Behavioral
Intervention description(s): exercise to look at balance and lower limb strength record in diary; sessions to discuss self-management ideas to modify risk of falling; combination of exercise sessions with education sessions to modify fall risk
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Prevention