Balance, Trunk Impairment and Fear of Falling in Multiple Sclerosis Patients With Incontinence
Condition: Multiple Sclerosis; Physical Therapy; Incontinence
MeSH terms: Multiple Sclerosis; Sclerosis
Study type: Observational

Summary: 
      The aim of the present study was to examine balance, trunk impairment, and fear of falling in
      MS patients with incontinence. Clinical symptoms of the MS patients are heterogenous, and
      they vary according to the lesion levels and the duration and the type of the disease. In the
      neurologic group,especially in MS patients, incontinence is observed even at early stages.

      Pelvic floor muscles contribute to continence by stabilizing the bladder neck and increasing
      the intraurethral pressure. Furthermore, they mechanically support the spine and the
      pelvis.This mechanical support is attained through an increase in sacroiliac joint stiffness
      and intra-abdominal pressure changes, which are important for spinal control. Along with
      incontinence, this mechanical support deteriorates resulting in some problems. By this way,
      postural function of pelvic floor muscles may alter in individuals with incontinence, and
      thus, lumbopelvic stabilization may be negatively affected. In addition, the activity of
      trunk muscles changes in individuals with incontinence, which may result in spinal movement
      and affect the posture. Therefore, balance disorders may develop. Postural sways caused by
      balance disorders and the decrease in postural corrections have been listed among risk the
      factors associated with falling.

      When literature is examined, there exists no study examining the effects of incontinence on
      balance, trunk impairment, and fear of falling in MS patients. For all these reasons,
      investigators think that incontinence in MS patients has an effect on balance, trunk
      impairment, and fear of fall.
    

Detailed description: 
      This study was aimed to investigate balance, trunk impairment, and fear of falling in MS
      patients with and without incontinence.

      The study was conducted in 35 MS patients with an age range of 24-58 years. The patients were
      divided into two groups based on the occurrence of incontinence. A neurologic examination was
      performed using the EDSS by a neurologist.

      Incontinence was measured with the Incontinence Severity Index (ISI), balance was measured
      with a Technobody® stabilometric platform, and fear of falling was measured with the Falls
      Efficacy Scale (FES).
    

Intervention name(s): Incontinence Severity; Balance; Trunk impairment; Fear of falling
Intervention type(s): Other; Other; Other; Other
Intervention description(s): The Incontinence Severity Index (ISI) was used to assess the MS patients' incontinence severity.The first item is scored between 1 and 4 and the second item is scored between 1 and 3. The total score is calculated by the multiplication of these two answers. The index score is classified as 1-2 slight, 3-6 moderate, 8-9 severe, and 12 very severe.; The patients were assessed while their bladders were empty. The static balance of the patients was measured with a Technobody® stabilometric platform. The patients were assessed while their bladders were empty. The test was performed as the patients' arms on the sides, eyes open and closed, and on two feet. Ellipse area, anterior-posterior sway, and medial-lateral sway scores were recorded.; Trunk impairment was assessed with the Trunk Impairment Scale (TIS) while the participants' bladders were empty. The scale evaluates static and dynamic sitting balance and trunk coordination through 17 items. Each item is scored between 0 and 3. The total score ranges between 0 and 23, and higher scores indicate a better balance performance.; Fear of falling was assessed using the Falls Efficacy Scale developed by Tinetti and colleagues. The scale has 10 items assessing the effect of fear of falling on the confidence level of the individuals while performing activities of daily living. Each items is scored by the participants between 0 (not at all concerned) and 10 (very concerned), and the total of the score ranges between 0 (low fall efficacy) and 100 (high fall efficacy)
Other intervention name(s): Evaluation; Evaluation; Evaluation; Evaluation
Observational model: Case-Control
Time perspective: Prospective
Sampling method: Non-Probability Sample
Study population: 
        multiple sclerosis with incontinence and multiple sclerosis without incontinence
      
Keywords: Multiple Sclerosis; Balance; Trunk impairment; Fear of falling; Incontinence