Clinical Edge

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Link Between Physiological and Perceived Fall Risk

Arch Phys Med Rehab; 2018 Oct; Gunn, et al

A recent study highlights the importance of considering both physiological and perceived fall risk in multiple sclerosis (MS) and the need to explore the complex interrelationships of perceptual and physiological risk factors in this population. Researchers conducted a secondary analysis of data from prospective cohort studies undertaken in the US, Australia, and the UK. The cohort consisted of ambulatory people with MS (n=416). All participants completed measures of physiological (Physiological Profile Assessment [PPA]) and perceived (Falls Efficacy Scale-international [FESi]) fall risk and prospectively recorded falls for 3 months. They found:

  • 155 (37%) of the participants were recurrent fallers (≥2 falls).
  • The PPA and the FESi independently predicted faller classification in logistic regression, which indicated that the odds of being classified as a recurrent faller significantly increased with increasing scores.
  • Classification and regression tree analysis divided the sample into 4 groups based on cutoff values for the PPA: 1) low physiological/low perceived risk, 2) low physiological/high perceived risk, 3) high physiological/low perceived risk, and 4) high physiological/high perceived risk.
  • Over 50% of participants had a disparity between perceived and physiological fall risk; most were in group 2.


Gunn H, Cameron M, Hoang P, Lord S, Shaw S, Freeman J. Relationship between physiological and perceived fall risk in people with multiple sclerosis: Implications for assessment and management. Arch Phys Med Rehab. 2018; 99(10):2022-2029. doi:10.1016/j.apmr.2018.03.019.