Lower limb strength differentiates between fallers and non-fallers with multiple sclerosis

Heather M DelMastro; Tracy Wall; Deirdre J McPartland; Erik S Plaia; Naomi J Trimble; Jennifer A Ruiz; Katherine Harris; Elizabeth S Gromisch

doi:10.1016/j.apmr.2025.01.001

Lower limb strength differentiates between fallers and non-fallers with multiple sclerosis

Arch Phys Med Rehabil. 2025 Jan 9:S0003-9993(25)00026-7. doi: 10.1016/j.apmr.2025.01.001. Online ahead of print.

Authors

Heather M DelMastro¹, Tracy Wall², Deirdre J McPartland², Erik S Plaia², Naomi J Trimble², Jennifer A Ruiz³, Katherine Harris², Elizabeth S Gromisch⁴

Affiliations

¹ Mandell Center for Multiple Sclerosis, Mount Sinai Rehabilitation Hospital, Trinity Health Of New England, Hartford, CT, USA; Department of Rehabilitative Medicine, Frank H. Netter MD School of Medicine at Quinnipiac University, North Haven, CT, USA. Electronic address: [email protected].
² Department of Physical Therapy, School of Health Sciences at Quinnipiac University, North Haven, CT, USA.
³ Mandell Center for Multiple Sclerosis, Mount Sinai Rehabilitation Hospital, Trinity Health Of New England, Hartford, CT, USA; Department of Rehabilitative Medicine, Frank H. Netter MD School of Medicine at Quinnipiac University, North Haven, CT, USA; Department of Medical Sciences, Frank H. Netter MD School of Medicine at Quinnipiac University, North Haven, CT, USA.
⁴ Mandell Center for Multiple Sclerosis, Mount Sinai Rehabilitation Hospital, Trinity Health Of New England, Hartford, CT, USA; Department of Rehabilitative Medicine, Frank H. Netter MD School of Medicine at Quinnipiac University, North Haven, CT, USA; Department of Medical Sciences, Frank H. Netter MD School of Medicine at Quinnipiac University, North Haven, CT, USA; Department of Neurology, University of Connecticut School of Medicine, Farmington, CT, USA.

PMID: 39798893
DOI: 10.1016/j.apmr.2025.01.001

Abstract

Objective: To determine whether hip flexion (HF), extension (HE), abduction (HA), knee flexion (KF) and extension (KE), and ankle plantarflexion (APF) and dorsiflexion (ADF) Maximum Voluntary Contraction (MVC) differentiates between non-fall and fall history in persons with MS (PwMS) after accounting for age, gender, fatigue, disability, and disease duration.

Design: Secondary analysis of a cross-sectional study.

Setting: Community-based comprehensive MS Center PARTICIPANTS: 172 persons with MS who completed a one-time visit INTERVENTIONS: Not applicable MAIN OUTCOME MEASURES: Lower limb (LL) MVC was measured for each muscle group as isometric peak torque (Newton-meter: Nm) of both limbs (Strongest: S; Weakest: W) using a Biodex Dynamometer and normalized by body weight (Nm/kg). Falls in the past 6-months were retrospectively collected and participants were classified as non-fall history (0 falls [non-fallers]; n = 78) or fall history (≥1 falls [fallers]; n = 94). Fall history was further categorized as occasional (1-2 falls [occasional fallers]; n = 51) and recurrent (≥3 falls [recurrent fallers]; n = 43).

Results: Overall differences between participants with and without a fall history were noted on both limbs, with post-hoc analyses showing that those with a fall history had significantly lower strength (p < .05) on all LL-W and HF-S, HE-S, HA-S, KF-S, and APF-S. When separated out by fall frequency, recurrent fallers had diminished strength on all LL-W and HF-S, HE-S, HA-S, and APF-S, while occasional fallers exhibited reductions on HA-W, KE-W, and KF-W compared to non-fallers. Recurrent and occasional fallers differed on HE-W.

Conclusion: All LL-W and aspects of LL-S differentiated between fallers and non-fallers, with further differences observed when fall history was separated by frequency. These findings provide the necessary information to clinicians to inform their plans of care to address falls in MS and provide education on the importance of maintaining LL strength.

Keywords: Accidental Falls; Lower Extremity; Multiple Sclerosis; Muscle Strength; Muscle Weakness.