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Impaired balance and fall risk in people with multiple sclerosis
Örebro University, School of Medical Sciences.ORCID iD: 0000-0002-2598-2317
2018 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The symptoms from the neurological disease multiple sclerosis vary from person to person and over time. Impaired balance is common in people with multiple sclerosis and can lead to falls. Fall frequency is high in people with multiple sclerosis, above 50%. Multiple sclerosis affects not only the person having the disease but also their next of kin. To be able to reduce fall risk it is important to know when, why and where people with multiple sclerosis fall, and how to improve balance and reduce falls with exercise. It is also important to know how the falls affect the residing next of kin to people with multiple sclerosis.

The overall aim of this thesis was to gain enhanced knowledge by investigating when and why people with MS fall and how these falls possibly affect their next of kin, and also to evaluate the effects and perceptions of participating in a specific balance exercise.

Data were gathered using four different data collections, and this thesis contains both qualitative and quantitative data.

The major finding in this thesis is that people with multiple sclerosis fall in the course of everyday life activities, most often in their own homes due to various intrinsic and extrinsic factors. Balance can be improved and falls reduced and everyday life may be made easier and facilitated after participating in the CoDuSe balance exercise. This is important also for the next of kin, since they are adapting, adjusting and renouncing their activities due to the falls of the PwMS, in order to make it work for the whole family.

Place, publisher, year, edition, pages
Örebro: Örebro University , 2018. , p. 94
Series
Örebro Studies in Medicine, ISSN 1652-4063 ; 184
Keywords [en]
Balance, exercise, falls, falls efficacy, gait, multiple sclerosis, next of kin, physiotherapy, qualitative research, randomized controlled trial
National Category
General Practice
Identifiers
URN: urn:nbn:se:oru:diva-68025ISBN: 978-91-7529-263-2 (print)OAI: oai:DiVA.org:oru-68025DiVA, id: diva2:1234138
Public defence
2018-11-16, Örebro universitet, Campus USÖ, hörsal C3, Södra Grev Rosengatan 32, Örebro, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2018-07-23 Created: 2018-07-23 Last updated: 2018-12-10Bibliographically approved
List of papers
1. Falls in people with multiple sclerosis: experiences of 115 fall situations
Open this publication in new window or tab >>Falls in people with multiple sclerosis: experiences of 115 fall situations
2018 (English)In: Clinical Rehabilitation, ISSN 0269-2155, E-ISSN 1477-0873, Vol. 32, no 4, p. 526-535Article in journal (Refereed) Published
Abstract [en]

Objectives: The aim was to describe falls and the perceived causes, experienced by people with multiple sclerosis shortly after falling.

Design: A qualitative study using content analysis and quantitative data to illustrate where and why people report falls most commonly. Semi-structured telephone interviews were performed. Interviews were conducted shortly (0–10 days) after a fall.

Subjects: In all, 67 informants who had reported at least one fall during the previous three-month period and who used a walking aid participated.

Results: A total of 57 (85%) informants fell at least once during eight months resulting in 115 falls; 90 (78%) falls happened indoors, most commonly in the kitchen (n = 20; 17%) or bathroom (n = 16; 14%). Informants fell during everyday activities and walking aids had been used in more than a third of the reported falls. The falls were influenced of both intrinsic and extrinsic factors. Two categories emerged from the analysis: ‘activities when falling’ and ‘influencing factors’. The category contained three (basic activities of daily living, instrumental activities of daily living and leisure and work) and six (multiple sclerosis–related symptoms, fluctuating body symptoms, being distracted, losing body control, challenging surrounding and involvement of walking aid) subcategories, respectively.

Conclusion: The majority of falls occurs indoors and in daily activities. Several factors interacted in fall situations and should be monitored and considered to reduce the gap between the person’s capacity and the environmental demands that cause fall risk. Fluctuation of bodily symptoms between and within a day is a variable not earlier targeted in multiple sclerosis fall risk research.

Place, publisher, year, edition, pages
Sage Publications, 2018
Keywords
Accidental falls, multiple sclerosis, walking aid, content analysis
National Category
Neurology Physiotherapy
Identifiers
urn:nbn:se:oru:diva-65948 (URN)10.1177/0269215517730597 (DOI)000429777600011 ()28901164 (PubMedID)2-s2.0-85042230415 (Scopus ID)
Available from: 2018-03-22 Created: 2018-03-22 Last updated: 2018-11-19Bibliographically approved
2. CoDuSe group exercise programme improves balance and reduces falls in people with multiple sclerosis: A multi-centre, randomized, controlled pilot study
Open this publication in new window or tab >>CoDuSe group exercise programme improves balance and reduces falls in people with multiple sclerosis: A multi-centre, randomized, controlled pilot study
2017 (English)In: Multiple Sclerosis, ISSN 1352-4585, E-ISSN 1477-0970, Vol. 23, no 10, p. 1394-1404Article in journal (Refereed) Published
Abstract [en]

Background: Imbalance leading to falls is common in people with multiple sclerosis (PwMS).

Objective: To evaluate the effects of a balance group exercise programme (CoDuSe) on balance and walking in PwMS (Expanded Disability Status Scale, 4.0-7.5).

Methods: A multi-centre, randomized, controlled single-blinded pilot study with random allocation to early or late start of exercise, with the latter group serving as control group for the physical function measures. In total, 14 supervised 60-minute exercise sessions were delivered over 7 weeks. Pretest-posttest analyses were conducted for self-reported near falls and falls in the group starting late. Primary outcome was Berg Balance Scale (BBS). A total of 51 participants were initially enrolled; three were lost to follow-up.

Results: Post-intervention, the exercise group showed statistically significant improvement (p = 0.015) in BBS and borderline significant improvement in MS Walking Scale (p = 0.051), both with large effect sizes (3.66; -2.89). No other significant differences were found between groups. In the group starting late, numbers of falls and near falls were statistically significantly reduced after exercise compared to before (p < 0.001; p < 0.004).

Conclusion: This pilot study suggests that the CoDuSe exercise improved balance and reduced perceived walking limitations, compared to no exercise. The intervention reduced falls and near falls frequency.

Place, publisher, year, edition, pages
London, United Kingdom: Sage Publications, 2017
Keywords
Accidental falls, exercise, multiple sclerosis, postural balance, core stability
National Category
Neurology
Identifiers
urn:nbn:se:oru:diva-53488 (URN)10.1177/1352458516677591 (DOI)000407918800014 ()27834736 (PubMedID)2-s2.0-85027895184 (Scopus ID)
Note

Funding Agencies:

Uppsala-Örebro Regional Research Committe  

Research committee of Örebro County Council  

Norrbacka-Eugenia Foundation 

Available from: 2016-11-14 Created: 2016-11-14 Last updated: 2018-11-19Bibliographically approved
3. Balance exercise facilitates everyday life for people with multiple sclerosis: A qualitative study
Open this publication in new window or tab >>Balance exercise facilitates everyday life for people with multiple sclerosis: A qualitative study
2018 (English)In: Physiotherapy Research International, ISSN 1358-2267, E-ISSN 1471-2865, Vol. 23, no 4, article id e1728Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES: The aim of this qualitative study was to describe the experience and perceived effects on everyday life for people with multiple sclerosis after participating in a balance exercise programme focusing on core stability, dual tasking, and sensory strategies (the CoDuSe programme).

METHODS: A qualitative approach was chosen, using face-to-face interviews analysed with content analysis. Twenty-seven people with multiple sclerosis (20 women, 7 men) who had participated in the CoDuSe programme were included. All could walk 20 m with or without walking aids but could not walk further than 200 m. The CoDuSe programme was given twice weekly during a 7-week period.

RESULTS: The analysis revealed five categories. Learning to activate the core muscles described how the participants gained knowledge of using their core muscles and transferred this core muscle activation into everyday life activities. Improved bodily confidence covered narratives of being more certain of the ability to control their bodies. Easier and safer activities showed how they could now perform activities in everyday life more safely and easily. Increased independence and participation involved the participants' improved ability and self-confidence to execute activities by themselves, as well as their increased participation in activities in daily living. Experiences of the balance exercise programme revealed that they found the programme novel and challenging. The overall theme was balance exercise facilitates everyday life.

CONCLUSION: Participating in the CoDuSe programme was perceived to facilitate everyday life for people with multiple sclerosis. Taking part in the balance exercise programme taught the participants how to activate and use the core muscles, which increased their bodily confidence. Having increased bodily confidence helped them to perform everyday life activities with more ease and safety, which increased their independence and participation. The participants described the CoDuSe programme as novel and challenging, yet feasible.

Place, publisher, year, edition, pages
John Wiley & Sons, 2018
Keywords
Exercise, multiple sclerosis, postural balance, qualitative research
National Category
Occupational Therapy Other Health Sciences
Research subject
Disability Science
Identifiers
urn:nbn:se:oru:diva-68373 (URN)10.1002/pri.1728 (DOI)000447159800008 ()29962013 (PubMedID)2-s2.0-85050613048 (Scopus ID)
Funder
Swedish Research Council
Note

Funding Agencies:

Norrbacka-Eugenia Foundation

Uppsala-Örebro Regional Research Committee

Available from: 2018-08-07 Created: 2018-08-07 Last updated: 2018-11-19Bibliographically approved
4. Making it work: experience of living with a person who falls due to multiple sclerosis
Open this publication in new window or tab >>Making it work: experience of living with a person who falls due to multiple sclerosis
(English)Manuscript (preprint) (Other academic)
National Category
General Practice
Identifiers
urn:nbn:se:oru:diva-70253 (URN)
Available from: 2018-11-19 Created: 2018-11-19 Last updated: 2018-11-19Bibliographically approved

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