Scale development to evaluate differences between concern about falling and fear of falling: the concern and fear of falling evaluation.

Purpose: Individuals with multiple sclerosis (MS) experience fear of falling (FOF), which is associated with negative health and quality-of-life consequences. Prior research has used FOF and concern about falling (CAF) interchangeably, but persons with MS report that CAF and FOF represent separate constructs that lie on a continuum. Unfortunately, no scale exists to understand the differences between CAF and FOF. Therefore, we developed a novel questionnaire, the Concern and Fear of Falling Evaluation (CAFFE), in which respondents rank their CAF and FOF on a continuum across various activities. This study aims to describe the scale development process and examine its psychometric properties. Methods: In a single online survey, MS participants responded to demographic questionnaires, indicated whether they experience CAF and FOF, and completed the CAFFE. Psychometric evaluation of the CAFFE involved internal consistency, split-half cross validation, exploratory factor analysis (EFA), and confirmatory factor analysis (CFA). Results: Out of 1,025 respondents, 64.6% reported CAF and 47.2% reported FOF. The EFA yielded a two-factor solution encompassing activities in open (factor 1) and closed environments (factor 2). The CFA replicated this two-factor solution and the CAFFE demonstrated excellent internal consistency (α = 0.98). Conclusion: The 27-item CAFFE is a highly reliable and valid measure capturing the tipping point at which point CAF moves to FOF. Future research should seek to define the tipping point from the MS community, as CAF may be an adaptive mechanism, whereas FOF may be a maladaptive behavior.

Relationship Between Fear of Falling and Physical Activity in People Aging With a Disability.

BACKGROUND: An estimated one billion people worldwide live with some form of disability and may face many challenges as they age, including increased fall risk. Understanding the risk factors linking falls, fear of falling, and activity restriction is critical for developing effective programs to increase activity levels among persons with disabilities. OBJECTIVES: To determine if differences exist in the level of physical activity in people with different types of conditions associated with disability and to investigate if fear of falling is associated with physical activity in individuals who are aging with a long-term disability. DESIGN: Cross-sectional retrospective design. SETTING: Community. PARTICIPANTS: A convenience sample of 1812 community-dwelling individuals who had one of four diagnoses: multiple sclerosis (MS), muscular dystrophy (MD), spinal cord injury (SCI), or post-polio syndrome (PPS). METHODS: Descriptive statistics, chi-square, and analysis of variance, followed by multivariate linear regression analysis were used to examine the association between physical activity status and fear of falling. MAIN OUTCOME MEASUREMENTS: Physical activity volume and fear of falling. RESULTS: After controlling for age, sex, duration of disability, and mobility level, there was variation across diagnostic groups (P < .001). People with SCI reported greater physical activity (M = 25.19) compared to other groups (MS: M = 18.70; MD: M = 21.83; PPS: M = 15.47). Patients with PPS had the greatest concerns about falling (M = 16.08), and patients with MS had the lowest (M = 13.12). Fear of falling was associated with physical activity (P < .001), which remained significant after controlling for diagnosis type, falls history, and level of mobility. CONCLUSION: Level of physical activity appears to vary among disability diagnoses. These results highlight the importance of addressing fear of falling in people with long-term disability because fear of falling is associated with physical activity.

Instrumented Version of the Modified Dynamic Gait Index in Patients With Neurologic Disorders.

BACKGROUND: Gait instability is common in adults with neurologic disorders and the modified Dynamic Gait Index (mDGI) was recently introduced to assess dynamic balance. However, instrumental assessment is needed to provide quantitative measures. OBJECTIVE: To develop and validate an instrumented version of the mDGI. DESIGN: Cross-sectional study. SETTING: Clinical setting. PARTICIPANTS: Thirty adults with neurologic disorders (10 with multiple sclerosis, 10 with Parkinson disease, and 10 with stroke) and 20 healthy volunteers. METHODS: Participants were assessed with the Timed Up and Go test (TUG) and with the mDGI. During the assessment of mDGI, data were collected by a single Inertial Measurement Unit (IMU) positioned on the sternum. Principal component analysis (PCA) was performed on the instrumented data extracting eight PC scores (ImPC) describing dynamic balance. The instrumented overall score (ImDGI) was then calculated as the sum of the mPCs. PCA revealed two components associated with stride features and regularity (ImDGI_Gait_Pattern) and trunk movements (ImDGI_Trunk_Sway). Spearman coefficients were calculated between mDGI and ImDGI, whereas Mann-Whitney (U) and Kruskal-Wallis (H) tests assessed differences between groups and neurologic conditions. MAIN OUTCOME MEASUREMENTS: ImDGI. RESULTS: ImDGI did not show ceiling effects, and good correlations were found between ImDGI and mDGI (r = .84), and TUG (r = .84) for people with neurologic disorders (P < .001). Significant differences among pathologies (H test(2) =12.5, P = .002) and between healthy participants and adults with neurologic disorders (U test = 47.0, P = .001) were found. ImDGI_Trunk_Sway discriminated between people using or not using walking aids and among the three pathologies (H(2) = 10.0, P = .007). CONCLUSIONS: The ImDGI test seems to provide valid measures to objectively assess dynamic balance in neurologic conditions and possibly quantify balance deficits also in adults with neurologic disorders.

Instilling positive beliefs about disabilities: pilot testing a novel experiential learning activity for rehabilitation students.

PURPOSE: To develop and test a novel impairment simulation activity to teach beginning rehabilitation students how people adapt to physical impairments. METHODS: Masters of Occupational Therapy students (n = 14) and Doctor of Physical Therapy students (n = 18) completed the study during the first month of their program. Students were randomized to the experimental or control learning activity. Experimental students learned to perform simple tasks while simulating paraplegia and hemiplegia. Control students viewed videos of others completing tasks with these impairments. Before and after the learning activities, all students estimated average self-perceived health, life satisfaction, and depression ratings among people with paraplegia and hemiplegia. RESULTS: Experimental students increased their estimates of self-perceived health, and decreased their estimates of depression rates, among people with paraplegia and hemiplegia after the learning activity. The control activity had no effect on these estimates. CONCLUSIONS: Impairment simulation can be an effective way to teach rehabilitation students about the adaptations that people make to physical impairments. Positive impairment simulations should allow students to experience success in completing activities of daily living with impairments. Impairment simulation is complementary to other pedagogical methods, such as simulated clinical encounters using standardized patients. Implication of Rehabilitation It is important for rehabilitation students to learn how people live well with disabilities. Impairment simulations can improve students' assessments of quality of life with disabilities. To be beneficial, impairment simulations must include guided exposure to effective methods for completing daily tasks with disabilities.

Participation as an Outcome in Multiple Sclerosis Falls-Prevention Research: Consensus Recommendation from the International MS Falls Prevention Research Network.

Selecting the outcomes for an intervention trial is a key decision that influences many other aspects of the study design. One of the major tasks during the 3-day inaugural meeting of the International MS Falls Prevention Research Network was to identify the key outcomes for the falls-prevention intervention that was being designed by the Network members for testing across their multiple sites. Through a nominal group process, meeting participants described how engagement in important, meaningful everyday activities, beyond traditional basic and instrumental activities of daily living, should be a long-term outcome of a successful falls-prevention intervention for people with MS. Post-meeting work, which involved literature reviews and comparisons of definitions of major constructs identified during the meeting discussions, led to the consensus recommendation of including participation as a long-term outcome in MS falls-prevention interventions. Participation reflects involvement in a life situation. This article explains the rationale for this recommendation and presents four measures that have the potential for use in tracking long-term participation outcomes in MS falls-prevention research.

Applying the RE-AIM Framework to Inform the Development of a Multiple Sclerosis Falls-Prevention Intervention.

Successfully addressing the problem of falls among people with multiple sclerosis (MS) will require the translation of research findings into practice change. This process is not easy but can be facilitated by using frameworks such as RE-AIM during the process of planning, implementing, and evaluating MS falls-prevention interventions. RE-AIM stands for Reach, Effectiveness, Adoption, Implementation, and Maintenance. Since its initial publication in 1999, the RE-AIM framework has become widely recognized across a range of disciplines as a valuable tool to guide thinking about the development and evaluation of interventions intended for widespread dissemination. For this reason, it was selected by the International MS Falls Prevention Research Network to structure initial discussions with clinicians, people with MS, and representatives of professional and MS societies about the factors we need to consider in the development of an MS falls-prevention intervention for multisite testing that we hope will someday be disseminated widely. Through a combination of small-group work and large-group discussion, participants discussed four of the five RE-AIM elements. A total of 17 recommendations were made to maximize the reach (n = 3), adoption (n = 5), implementation (n = 4), and maintenance (n = 5) of the intervention the Network is developing. These recommendations are likely to be useful for any MS rehabilitation researcher who is developing and testing interventions that he or she hopes will be widely disseminated.

Falls in multiple sclerosis.

OBJECTIVE: To examine incidence, associated factors, and health care provider (HCP) response to falls in persons with multiple sclerosis (MS). DESIGN: Cross-sectional retrospective design. SETTING: Community setting. PARTICIPANTS: Four hundred seventy-four persons with MS. METHODS: Mailed survey questionnaire examined incidence, risk factors, and HCP response to falls in persons with MS who were dwelling in the community. Univariate and multiple ordinal regression analysis identified variables associated with single and multiple falls. MAIN OUTCOME MEASUREMENTS: Falls, causes and perceived reasons for falls, and HCP response. RESULTS: A total of 265 participants (58.2%) reported one or more falls in the previous 6 months, and 58.5% of falls were medically injurious. Trips/slips while walking accounted for 48% of falls. Factors associated with falls included use of a cane or walker (odds ratio [OR] 2.62; 95% confidence interval [CI] 1.66-4.14), income <$25,000 (OR 1.85; 95% CI 1.13-3.04), balance problems (OR 1.28; 95% CI 1.11-1.49), and leg weakness (OR 1.26; 95% CI 1.09-1.46). Fifty-one percent of those who fell (135/265) reported speaking to an HCP about their falls; recommended strategies included safety strategies (53.2%), use of gait assistive devices (42.1%), exercise/balance training (22.2%), and home modifications (16.6%). CONCLUSIONS: Factors associated with falls in persons with MS are similar to those in other populations with neurologic diseases. Despite the high incidence of falls, fewer than 50% of people with MS receive information about prevention of falls from an HCP.