To evaluate fall risk in a well-phenotyped prospective multiple sclerosis (MS) cohort and analyze associations between falling and clinical, patient-reported, and remote activity metrics.

Ninety-four people with MS who were able to walk >2 minutes with or without an assistive device were prospectively recruited. Clinic-based measures were recorded at study entry and 1-year later. Average daily step count (STEPS) was continuously recorded using a wrist-worn accelerometer (Fitbit Flex) and patient-reported outcomes (PROs), including the 12-Item MS Walking Scale (MSWS-12) and a fall survey, were completed at study entry, 1.5, 3, 6, 9, and 12 months.

Of 94 participants, 50 (53.2%) reported falling at least once over 1-year. Only 56% of patients who reported a fall on the study survey had clinical documentation of falling in the electronic medical record from routine care. ‘Fallers’ had greater disability [median EDSS 5.5 (IQR 4.0 – 6.0) versus 2.5 (IQR 1.5 - 4.0)], were more likely to have progressive MS (p=0.003), and took fewer STEPS (mean difference -1,979, p=0.007) than non-fallers. Stepwise regression revealed MSWS-12 to be the top remote predictor of future falls. The World Health Organization Disability Assessment Schedule, MFIS-5 (fatigue) and baseline STEPS were also found to be relevant fall predictors at surveys; 3, 6 and 12 months.

Falling is common in people with MS and is both under-reported and under-recognized in routine clinical care. Multimodal fall screening in clinic or remotely, including directly asking patients about prior falls, PROs (MSWS-12) and recognition of low STEPS on remote activity monitoring, may help improve patient care by identifying patients at greatest risk of falling and allow for timely intervention and referral to specialized physical rehabilitation services.