Multiple Sclerosis (MS) is one of the most prevalent diseases of the central nervous system (CNS) and directly affects an estimated 2.5 million people worldwide (MS International Federation 2013) including approximately 8,000 people in Ireland (MS Ireland 2014). It is the most common disabling neurological disorder among young people but it can occur at any age. It is an immune-mediated disease characterised by inflammatory demyelination and neurodegeneration within the CNS. This impairment of CNS structures in turn leads to impairments in cognition, muscle strength, muscle tone, sensation, coordination and gait, all of which are associated with an increased risk for falls. Falls are a common and serious health concern in people with MS. A primary motivator for completing this Cochrane systematic review relates to the high prevalence of falls among people with MS. Falls rates (measured using both retrospective and prospective measures) range from 50 to 63% among people with MS (Cattaneo et al 2002, Finlayson et al 2006, and Peterson et al 2008, Nilsagard et al 2014) and many people with MS fall recurrently (Cameron et al 2015). The majority of falls require medical attention (Matsuda et al 2011, Peterson et al 2008, Bazelier et al 2011) and people with MS are four times more likely to suffer a hip fracture brought about by a fall than age- and gender-matched peers without MS (Bazelier et al 2011). Of particular note, people with MS who have previously fallen report significantly poorer physical and psychological health status compared with non-fallers with MS (Coote et al 2013). Falls can further have an adverse impact on fear of falling and falls self-efficacy and contribute to activity curtailment, physiological deconditioning, loss of independence, and institutionalization (Finlayson et al 2010, Matsuda et al 2012). Given the high prevalence of falls among people with MS and the associated serious and wide-ranging consequences, there has been increased number of randomised controlled trials evaluating the effect of falls prevention interventions among people with MS. Types of multidisciplinary falls interventions among people with MS may include but are not restricted to:
Exercise interventions, e.g. aerobic exercise, strengthening exercise, balance exercises aimed at improving balance function, Sensory integration training or a combination exercise interventions;
Nutritional interventions, e.g. Vitamin D;
Neuromuscular stimulation interventions, e.g. functional electrical stimulation devices;
Educational interventions, e.g. education sessions on self-management principles for preventing falls;
Technology-enhanced interventions, e.g. robot-assisted technological interventions;
Review objective: To evaluate the effectiveness of interventions aimed at preventing falls in people with MS.
