Multiple sclerosis severity and concern about falling: Physical, cognitive and psychological mediating factors

BACKGROUND: Concern about falling can have devastating physical and psychological consequences in people with multiple sclerosis (MS). However, little is known about physical and cognitive determinants for increased concern about falling in this group. OBJECTIVE: To investigate direct and indirect relationships between MS severity and concern about falling using structural equation modelling (SEM). METHODS: Two hundred and ten community-dwelling people (21-73 years) with MS Disease Steps 0-5 completed several physical, cognitive and psychological assessments. Concern about fallingwas assessed using the Falls Efficacy Scale-International. RESULTS: Concern about falling was significantly associated with MS Disease Step and also balance, muscle strength, disability, previous falls, and executive functioning. SEM revealed a strong direct path between MS Disease Step and concern about falling (r = 0.31, p < 0.01), as well as indirect paths explained by impaired physical ability (r = 0.25, p < 0.01) and reduced cognitive function (r = 0.13, p < 0.01). The final model explained 51% of the variance of concern about falling in people with MS and had an excellent goodness-of-fit. CONCLUSIONS: The relationship between MS severity and increased concern about falling was primarily mediated by reduced physical ability (especially if this resulted in disability and falls) and less so by executive functioning. This suggests people with MS have a realistic appraisal of their concern about falling.