Frequent falls and the fear of falling (FOF) are significant challenges experienced by individuals with multiple sclerosis (MS). Previously, FOF was defined as an ongoing concern about falling (CAF); however, individuals living with MS have expressed that FOF differs from CAF. While FOF is recognized to be associated with physical and cognitive impairments, it remains unclear whether CAF affects individuals differently than FOF and whether the impact of FOF varies depending on the subtype of MS. This study aimed to investigate the prevalence and associations of FOF and CAF with functional abilities in individuals with relapsing-remitting MS (RRMS) and progressive MS (PMS)

A survey involving 1,025 participants with multiple sclerosis (695 with relapsing-remitting MS [RRMS], 301 with progressive MS [PMS], and 29 with unknown subtypes) highlighted the distinct nature of FOF and ongoing CAF. The study revealed that individuals with PMS reported higher rates of FOF (59.1%) and CAF (80.1%) compared to those with RRMS (41.6% and 57.0%, respectively). Notably, 60.2% of all participants acknowledged that FOF and CAF represented separate constructs. The survey employed the CF-Fall scale, which allowed participants to rate their FOF and CAF during 28 activities. Correlations showed that CF-Fall exhibited the strongest associations with avoidance behavior (r = 0.82), walking impairment (r = 0.83), physical function (r = -0.84), and lower extremity function (r = -0.85) (all P < .001). Furthermore, comparisons between individuals with RRMS and PMS indicated significant differences. Those with PMS displayed higher levels of FOF (59.1%) and CAF (80.1%), as well as higher scores on CF-Fall, avoidance behavior, walking ability, physical function, cognitive function, life-space mobility, and lower extremity function (all P < .001), compared to individuals with RRMS.

The study’s findings stress the importance of separately assessing the prevalence of FOF and CAF in different MS subtypes. The prevalence rates observed in the overall sample were lower than the PMS group, highlighting the need for individualized evaluation. The results underscore the importance of considering cognitive, psychological, and motor factors when addressing FOF and CAF. Future therapeutic interventions should incorporate these aspects to provide more effective treatment strategies.