# PROMs reveal early fall risk in the absence of clinical disability in people with multiple sclerosis

## TL;DR

This study shows that people with early-stage multiple sclerosis often fear falling and may be at risk of falling even without visible disability, and patient-reported measures can help identify these risks early.

## Contribution

The study demonstrates the utility of PROMs in identifying fall risk in pwMS with low disability, which is novel in early intervention strategies.

## Key findings

- Fear of falling was significantly higher in people with MS compared to healthy controls.
- MSWS-12 and disease duration were significant predictors of fear of falling.
- PROMs like MSWS-12 and FES-I are valuable for identifying fall-prone individuals with low disability.

## Abstract

Falls and fear of falling (FoF) are common in people with multiple sclerosis (pwMS), even in the absence of significant physical disability. To identify the determinants of falls in pwMS with low disability (EDSS < 4.0) and to examine the utility of patient-reported outcome measures (PROMs) in guiding timely fall prevention strategies.

Fifty RRMS patients (EDSS < 4.0, aged 18–50 years) and 30 age, sex, and education-matched healthy controls were assessed. Participants were evaluated for fall history (retrospective and prospective), static and dynamic balance, gait speed (T25FW), walking limitations (MSWS-12), cognitive function (MoCA), depression (BDI-II), and fear of falling (FES-I). Correlation and regression analyses were conducted to identify factors associated with FoF.

Falls occurred in 48% of pwMS and 30% of healthy subjects (HC) (p = 0.1). FoF was significantly more common in pwMS (50%) than in HCs (23.3%, p = 0.001). MS patients who fell had significantly higher MSWS-12 and FES-I scores than non-fallers (p = 0.001 and p = 0.01, respectively). FoF positively correlated with age, disease duration, EDSS, static balance, and MSWS-12, and negatively with education level. In linear regression, MSWS-12 (p < 0.001) and disease duration (p = 0.03) were significant predictors of FoF.

FoF is common among pwMS even at low disability levels and may contribute to fall risk and activity restriction. PROMs, particularly MSWS-12 and FES-I, are valuable tools for identifying fall-prone individuals and should be integrated into routine clinical assessments to enable early intervention.

The online version contains supplementary material available at 10.1007/s10072-025-08605-w.