Backward and forward walking and its association with falls and fear of falling in people with multiple sclerosis

Common symptoms in people with multiple sclerosis (pwMS) are walking limitations that can reduce the quality of life and lead to an increased risk of falling and fear of falling [1,2]. Instrumented gait analysis on a walkway with integrated pressure sensors can be used for assessment of both forward and backward walking. Walking backwards has been established as a more sensitive parameter to detect fallers, compared to walking forwards [3]. It is unknown whether fear of falling can be already detected by walking backwards. For possible interventions, it is important to identify patients with falls resp. fear of falling as early as possible. Is there an association between forward and backward walking and falls resp. fear of falling in pwMS? 705 pwMS (71.6% female, 82.1% with relapsing remitting MS) completed three test conditions on an eight-meter pressor sensor walking way (GAITRite® System) without shoes: (i) walking forwards at a self-selected normal speed, (ii) walking forwards at fast speed and (iii) walking backwards at the highest possible speed. In addition, fall history and fear of falling in the previous month were assessed. Velocity, step length and stance phase of gait cycle were determined in all test conditions. In walking backwards condition, time for 3-meter backward walking test (3MBWT) was additionally included in the analysis. Multiple logistic regressions adjusted for age, gender, body mass index (BMI) and Expanded Disability Status Scale (EDSS) were applied. Of 705 pwMS, 10.6% were fallers (n=75; age: 46.52 ±10.79; BMI: 26.05 ±5.66; EDSS median: 3.5), while 31.9% presented with fear of falling (n=225; age: 47.58 ±11,29; BMI: 25.73 ±5.01; EDSS median: 3.5). Step length during fast walking (odds ratio (OR) 0.982; CI 0.966-0.998) and velocity during walking backwards proved to be significant indicators of falls with an OR of 0.982 (CI 0.970-0.995). All parameters of walking backwards (velocity, step length, stance of cycle and 3MBWT) and stance of cycle in normal walking could be proven as an indicator of fear of falling (see Fig. 1). In addition to identifying patients at risk of falling [3], the results suggest that walking backwards also can identify pwMS presenting with fear of falling. Longitudinal analyses will be performed to validate the clinical utility of walking backwards. Fig. 1.Download : Download high-res image (111KB)Download : Download full-size image