Identification of risk factors for falls in people with multiple sclerosis: a systematic review of prospective studies

ABSTRACT The objective of this study was to identify demographic, clinical, and instrumental variables associated with falls in people with multiple sclerosis (MS), via systematic review, based on prospective data. The search was conducted in these databases: Medline, Web of Science, Bireme e CINAHL via a search strategy that combined the descriptors “multiple sclerosis”, “falls”, “accidental falls”, “fall risk”, “postural control” and “balance”, followed by manual search. Eligibility criteria were prospective cohort studies with a minimum 3-month follow-up of falls that assessed the association of a demographic, clinical or instrumental variable in relation to a higher fall risk in people with MS. The modified Newcastle-Ottawa Quality Assessment Scale was used for study quality assessment. A total of 357 studies were identified, of which 12 were included in the systematic review and 1,270 patients were included. In this study, 740 (58.26%) patients were classified as fallers, 396 (31.18%) patients had recurrent falls (2≥falls within the stipulated period) and 530 patients (41.74%) were classified as non-fallers. Except for spasticity and dual task cost in gait speed, all investigated variables showed conflicting results regarding their association with a higher fall risk. More studies with clinical homogeneity phenotypes of MS individuals and using validated assessment instruments are necessary to establish a robust association of other clinical, instrumental, and demographic variables with a higher fall risk.