To examine clinical predictors of fall(s)/near fall(s) and fall-related injuries in patients with early multiple sclerosis (MS).

Impaired balance is common in MS and not well measured by traditional clinical scales such as the Expanded Disability Status Scale (EDSS), particularly early in disease.

MS patients (<5 years diagnosed) from the Reserve Against Disability in Early Multiple Sclerosis (RADIEMS) Cohort completed balance assessments at baseline: (a) Balance Board (novel brief tandem walks across two wooden boards of differing widths [4.5 in, 1.5 in]; total number of successes across 3 trials of each board, range: 0–6), (b) NIH Toolbox Standing Balance Test (postural sway during five stances), (c) EDSS (0, 1, 1.5, 2-2.5, >3), and (d) Timed 25 Foot Walk (T25FW). Patients were surveyed one year after initial study visit to assess frequency of fall(s)/near fall(s) within the last month and fall-related injuries within the past year.

Of 154 patients with one-year follow up, 32.5% reported at least one fall/near fall and 29.2% reported fall-related injuries. Total number of successful Balance Board trials was the best predictor of fall/near fall (p<0.001) and was the only independent predictor of fall-related injury (p<0.0001). EDSS also predicted fall/near fall, but to a lesser degree (p=0.008). Of participants with EDSS < 2 (n=124), only total successful Balance Board trials predicted fall risk (p<0.001). In those unable to successfully complete any Balance Board trials (n=17), the chance of fall/near fall was 88.2% in the ensuing year.

Performance on a novel, brief, clinically-feasible balance task was the best predictor of both incident fall/near fall and fall-related injury in a cohort of early MS patients. These results highlight the need (and a potential tool) for more sensitive clinical measurement of more subtle but meaningful disease-related imbalance in the neurologist’s office and clinical trials.