An investigation of accidental falls in people with multiple sclerosis
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More than 50% of people with MS fall in any six-month period. The importance of developing a suitable falls management programme has been identified by people with MS and professionals. This thesis aimed to develop a model for an MS falls intervention. The studies employed a systematic approach to evaluate the risk factors for falls and to identify the optimal programme content, format and structure. Methods The thesis comprises two sections; the first involving a systematic review and an observational study of falls risk factors (n=148). Part two included a second systematic review to inform programme content, and a nominal group study (n=36) to explore approach, format and structure from the perspective of key stakeholders. Results Part one identified the potential target group (people at key mobility transition stages and those with progressive MS), and mechanisms by which the intervention could act (the identification of specific risk factors associated with falls in MS). These include non-modifiable disease and demographic characteristics (e.g. MS classification and gender), and potentially modifiable clinical characteristics (including balance, mobility, continence issues and medication usage). Part two identified that an MS specific falls programme should address falls and participation-related outcomes, incorporating educational activities and a programme of individually tailored gait, balance and functional training. The programme should use a collaborative approach; supporting participants to achieve sufficient intensity and duration of exercise and to integrate falls prevention strategies into their daily lives. The programme should enable participants to engage flexibly according to individual needs and preferences.
Conclusions This thesis has identified specific risk factors associated with accidental falls in MS. The evaluation indicates that the success and sustainability of an MS falls programme requires that it is MS specific, employs a collaborative approach and moves away from the group-based, weekly format common to many generic falls programmes.
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