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Article ; Online: Effectiveness of non-pharmacological falls prevention interventions for people with Multiple Sclerosis, Parkinson's Disease and stroke: protocol for an umbrella review.

O'Malley, Nicola / Clifford, Amanda M / Comber, Laura / Coote, Susan

HRB open research

2020 Volume 3, Page(s) 17

Abstract: Background: ...

Abstract	Background:
Language	English
Publishing date	2020-12-01
Publishing country	Ireland
Document type	Journal Article
ISSN	2515-4826
ISSN (online)	2515-4826
DOI	10.12688/hrbopenres.13023.2
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Fall definitions, faller classifications and outcomes used in falls research among people with multiple sclerosis: a systematic review.

O'Malley, Nicola / Clifford, Amanda M / Comber, Laura / Coote, Susan

Disability and rehabilitation

2020 Volume 44, Issue 6, Page(s) 856–864

Abstract: Purpose: To identify the definitions of a fall, faller classifications and outcomes used in prospectively-recorded falls research among people with Multiple Sclerosis (MS).: Methods: A systematic review of peer-reviewed journal articles was conducted ...

Abstract	Purpose: To identify the definitions of a fall, faller classifications and outcomes used in prospectively-recorded falls research among people with Multiple Sclerosis (MS). Methods: A systematic review of peer-reviewed journal articles was conducted using electronic databases. Relevant data were extracted by one reviewer and verified by a second independent reviewer. Results: Twenty-six papers met the inclusion criteria. A relative degree of heterogeneity existed amongst studies for the outcomes of interest to this review. Thirteen different fall definitions were identified. Fourteen different falls outcomes were used across the included studies, with six of these reported by only one study each. Data regarding injurious falls were presented by only eight papers. The majority ( Conclusions: This review highlights the large variation in fall definitions, faller classifications and outcomes used in this research field. This hinders cross-comparison and pooling of data, thereby preventing researchers and clinicians from drawing conclusive findings from existing literature. The creation of an international standard for the definition of a fall, faller classification and falls outcomes would allow for transparent and coordinated falls research for people with MS, facilitating progression in this research field.Implications for rehabilitationFalls are a common occurrence among people with Multiple Sclerosis (MS) resulting in numerous negative consequences.There is large heterogeneity in the definitions, methods and outcomes used in falls research for people with MS.This lack of standardisation prevents the accurate cross-comparison and pooling of data, impeding the identification of falls risk factors and effective falls prevention interventions for people with MS.Consequently, clinicians should interpret the outcomes of falls research for people with MS with caution, particularly when comparing studies regarding falls risk assessments and falls prevention interventions for use in clinical practice.
MeSH term(s)	Humans ; Multiple Sclerosis ; Risk Assessment ; Risk Factors
Language	English
Publishing date	2020-07-06
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't ; Systematic Review
ZDB-ID	1104775-6
ISSN	1464-5165 ; 0963-8288
ISSN (online)	1464-5165
ISSN	0963-8288
DOI	10.1080/09638288.2020.1786173
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Article ; Online: Challenges encountered during the systematic review of newer and enhanced influenza vaccines and recommendations for the future.

Teljeur, Conor / Comber, Laura / Jordan, Karen / Murchu, Eamon O / Harrington, Patricia / O'Neill, Michelle / Ryan, Máirín

Reviews in medical virology

2022 Volume 32, Issue 5, Page(s) e2335

Abstract: There are a variety of challenges in the conduct of systematic reviews of influenza vaccines. We describe our experience of completing four systematic reviews of newer and enhanced inactivated seasonal influenza vaccines. The reporting of the included ... ...

Abstract	There are a variety of challenges in the conduct of systematic reviews of influenza vaccines. We describe our experience of completing four systematic reviews of newer and enhanced inactivated seasonal influenza vaccines. The reporting of the included studies created significant challenges for study identification, data extraction and analysis. Those challenges have implications for the resources required to conduct reviews and, more significantly, for the accuracy of the estimated treatment effect. There is a substantial burden of morbidity and mortality associated with seasonal influenza, and the evidence used to support vaccination strategies requires regular review. An improved review process will facilitate robust decision-making both nationally and internationally. We recommend the development of reporting guidelines, increased engagement between researchers and decision makers, a database of identified trials, and research into search optimisation.
MeSH term(s)	Humans ; Influenza Vaccines ; Influenza, Human/prevention & control ; Systematic Reviews as Topic ; Vaccination ; Vaccines, Inactivated
Chemical Substances	Influenza Vaccines ; Vaccines, Inactivated
Language	English
Publishing date	2022-02-22
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	1086043-5
ISSN	1099-1654 ; 1052-9276
ISSN (online)	1099-1654
ISSN	1052-9276
DOI	10.1002/rmv.2335
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Effectiveness of non-pharmacological falls prevention interventions for people with Multiple Sclerosis, Parkinson’s Disease and stroke

Nicola O'Malley / Amanda M. Clifford / Laura Comber / Susan Coote

HRB Open Research, Vol

protocol for an umbrella review [version 2; peer review: 3 approved]

2020 Volume 3

Abstract: Background: Falls are common among people with neurological diseases and have many negative physical, psychosocial and economic consequences. Implementation of single-diagnosis falls prevention interventions is currently problematic due to lack of ... ...

Abstract	Background: Falls are common among people with neurological diseases and have many negative physical, psychosocial and economic consequences. Implementation of single-diagnosis falls prevention interventions is currently problematic due to lack of participants and resources. Given the similarities in falls risk factors across stroke, Parkinson’s Disease (PD) and Multiple Sclerosis (MS), the development of an intervention designed for mixed neurological populations seems plausible and may provide a pragmatic solution to current implementation challenges. This umbrella review aims to summarise the totality of evidence regarding the effectiveness of non-pharmacological falls prevention interventions for people with MS, PD and stroke and identify the commonalities and differences between effective interventions for each disease to inform the development of an evidence-based intervention that can be tailored for people with mixed diagnoses. Methods: This umbrella review will be conducted and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. 15 electronic databases and grey literature will be searched. Systematic reviews of randomised controlled trials and studies investigating the effects of non-pharmacological falls prevention interventions on falls outcomes among people with MS, PD and stroke will be included. Methodological quality of included reviews will be assessed using the Assessment of Multiple Systematic Reviews 2 tool. The Grading of Recommendations Assessments, Development and Evaluation framework will be used to rate the quality of evidence. A summary of evidence table and narrative synthesis will be utilised to clearly indicate the findings. Discussion: This umbrella review presents a novel and timely approach to synthesise existing falls literature to identify effective non-pharmacological interventions for people with MS, PD and stroke. Of importance, a robust methodology will be used to explore the differences and similarities in ...
Keywords	Medicine ; R
Subject code	306
Language	English
Publishing date	2020-12-01T00:00:00Z
Publisher	F1000 Research Ltd
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article: Development of the Better Balance Program for People with Multiple Sclerosis: A Complex Fall-Prevention Intervention.

Comber, Laura / Peterson, Elizabeth / O'Malley, Nicola / Galvin, Rose / Finlayson, Marcia / Coote, Susan

International journal of MS care

2020 Volume 23, Issue 3, Page(s) 119–127

Abstract: Background: Approximately 56% of people with multiple sclerosis (MS) will fall in any 3-month period, with the potential for physical, psychological, and social consequences. Fall-prevention research for people with MS is in its infancy, with a timely ... ...

Abstract	Background: Approximately 56% of people with multiple sclerosis (MS) will fall in any 3-month period, with the potential for physical, psychological, and social consequences. Fall-prevention research for people with MS is in its infancy, with a timely need to develop theory-based interventions that reflect the complexity of falls. The clear articulation of the development of any complex intervention is paramount to its future evaluation, usability, and effectiveness. Our aim was to describe how the development of Better Balance, a complex multicomponent fall-prevention intervention for people with MS, was guided by the Medical Research Council framework for the development of complex interventions. Methods: Sources of information included existing literature, original research, clinician interviews, and views of people with MS. These sources were synthesized and refined through an iterative process of intervention development involving researchers, clinicians, and people with MS. Results: The resulting intervention is outlined through a variety of key tasks supplementing the original Medical Research Council framework. Use of this framework resulted in a theoretically based and user-informed complex intervention designed to address the physiological, personal, and behavioral risk factors associated with falls in people with MS. Conclusions: The articulation of the systematic process used to develop Better Balance will inform the future evaluation and usability of the intervention.
Language	English
Publishing date	2020-07-01
Publishing country	United States
Document type	Journal Article
ISSN	1537-2073
ISSN	1537-2073
DOI	10.7224/1537-2073.2019-105
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article: Falls in People with Multiple Sclerosis: Risk Identification, Intervention, and Future Directions.

Coote, Susan / Comber, Laura / Quinn, Gillian / Santoyo-Medina, Carme / Kalron, Alon / Gunn, Hilary

International journal of MS care

2020 Volume 22, Issue 6, Page(s) 247–255

Abstract: Falls are highly prevalent in people with multiple sclerosis (MS) and result in a range of negative consequences, such as injury, activity curtailment, reduced quality of life, and increased need for care and time off work. This narrative review aims to ... ...

Abstract	Falls are highly prevalent in people with multiple sclerosis (MS) and result in a range of negative consequences, such as injury, activity curtailment, reduced quality of life, and increased need for care and time off work. This narrative review aims to summarize key literature and to discuss future work needed in the area of fall prevention for people with MS. The incidence of falls in people with MS is estimated to be more than 50%, similar to that in adults older than 80 years. The consequences of falls are considerable because rate of injury is high, and fear of falling and low self-efficacy are significant problems that lead to activity curtailment. A wide range of physiological, personal, and environmental factors have been highlighted as potential risk factors and predictors of falls. Falls are individual and multifactorial, and, hence, approaches to interventions will likely need to adopt a multifactorial approach. However, the literature to date has largely focused on exercise-based interventions, with newer, more comprehensive interventions that use both education and exercise showing promising results. Several gaps in knowledge of falls in MS remain, in particular the lack of standardized definitions and outcome measures, to enable data pooling and comparison. Moving forward, the involvement of people with MS in the design and evaluation of programs is essential, as are approaches to intervention development that consider implementation from the outset.
Language	English
Publishing date	2020-09-14
Publishing country	United States
Document type	Journal Article
ISSN	1537-2073
ISSN	1537-2073
DOI	10.7224/1537-2073.2020-014
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Risk factors for falling for people with Multiple Sclerosis identified in a prospective cohort study.

Quinn, Gillian / Comber, Laura / McGuigan, Chris / Hannigan, Ailish / Galvin, Rose / Coote, Susan

Clinical rehabilitation

2020 Volume 35, Issue 5, Page(s) 765–774

Abstract: Objective: To identify risk factors for falling for people with Multiple Sclerosis.: Design: Prospective cohort study.: Setting: Neurology service in a tertiary hospital.: Subjects: Participants were 101 people with Multiple Sclerosis and ... ...

Abstract	Objective: To identify risk factors for falling for people with Multiple Sclerosis. Design: Prospective cohort study. Setting: Neurology service in a tertiary hospital. Subjects: Participants were 101 people with Multiple Sclerosis and Expanded Disability Status Score of 3-6.5. One participant withdrew after the baseline assessment; data were analysed for 100 participants. Interventions: No intervention. Main measures: Outcome was rate of falls, and predictors were Timed Up and Go, Symbol Digit Modalities test, demographics and 15 self-report questions about various symptoms including fatigue, concentration, dual tasking, bladder and bowel control. Three-month prospective diaries recorded falls. Results: There were 791 falls reported over the 3-month period from a total of 56 fallers. Falls rate per person-year was 32.08 falls. Following multivariable regression analysis, the model with the greatest levels of clinical utility and discriminative ability (sensitivity 88% and area under the receiving operating curve statistic = 0.72, 95% CI 0.62-0.82), included the variables of history of a fall, not having visual problems, problems with bladder control and a slower speed on the Timed Up and Go. Conclusion: This study confirms the high incidence of falls for people with Multiple Sclerosis and provides a risk prediction model including fall history, problems with bladder control, not having visual problems and a slower Timed Up and Go speed that may be used to identify those at greater risk and in need of tailored falls prevention intervention.
MeSH term(s)	Accidental Falls/prevention & control ; Accidental Falls/statistics & numerical data ; Adult ; Aged ; Fatigue/complications ; Female ; Humans ; Incidence ; Male ; Middle Aged ; Multiple Sclerosis/complications ; Multiple Sclerosis/physiopathology ; Multiple Sclerosis/psychology ; Neuropsychological Tests ; Postural Balance ; Prospective Studies ; Risk Factors
Language	English
Publishing date	2020-12-16
Publishing country	England
Document type	Journal Article
ZDB-ID	639276-3
ISSN	1477-0873 ; 0269-2155
ISSN (online)	1477-0873
ISSN	0269-2155
DOI	10.1177/0269215520973197
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Zs.A 2297: Show issues

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Article ; Online: Gait deficits in people with multiple sclerosis: A systematic review and meta-analysis.

Comber, Laura / Galvin, Rose / Coote, Susan

Gait & posture

2017 Volume 51, Page(s) 25–35

Abstract: Background: Multiple Sclerosis (MS) results in postural instability and gait abnormalities which are associated with accidental falls.: Objective: This systematic review and meta-analysis aims to quantify the effect of MS on gait to inform the ... ...

Abstract	Background: Multiple Sclerosis (MS) results in postural instability and gait abnormalities which are associated with accidental falls. Objective: This systematic review and meta-analysis aims to quantify the effect of MS on gait to inform the development of falls prevention interventions. Methods: A systematic literature search identified case-control studies investigating differences in gait variables between people with MS and healthy controls. Meta-analysis examined the effect of MS on gait under normal and fast paced conditions. Results: Forty-one studies of people with Expanded Disability Status Scale (EDSS) 1.8 to 4.5 were included, of which 32 contributed to meta-analysis. A large effect of MS was found on stride length (Standardised Mean Difference, SMD=1.27, 95% CI{0.93, 1.61}), velocity (SMD=1.12, 95% CI{0.85, 1.39}), double support duration (SMD=0.85, 95% CI{0.51, 1.2}), step length (SMD=1.15, 95% CI{0.75, 1.5})and swing phase duration (SMD=1.23, 95% CI{0.06, 2.41}). A moderate effect was found on step width and stride time with the smallest effect found on cadence (SMD=0.43, 95% CI{0.14, 0.72}). All effect sizes increased for variables investigated under a fast walking pace condition (for example the effect on cadence increased to SMD=1.15, 95% CI{0.42, 1.88}). Conclusions: MS has a significant effect on gait even for those with relatively low EDSS. This effect is amplified when walking at faster speeds suggesting this condition may be more beneficial for assessment and treatment. No studies investigated the association between these deficits and falls. Further investigation relating to the predictive or protective nature of these deficits in relation to falls is warranted.
Language	English
Publishing date	2017-01
Publishing country	England
Document type	Review ; Journal Article
ZDB-ID	1162323-8
ISSN	1879-2219 ; 0966-6362
ISSN (online)	1879-2219
ISSN	0966-6362
DOI	10.1016/j.gaitpost.2016.09.026
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Article ; Online: The ability of clinical balance measures to identify falls risk in multiple sclerosis: a systematic review and meta-analysis.

Quinn, Gillian / Comber, Laura / Galvin, Rose / Coote, Susan

Clinical rehabilitation

2017 Volume 32, Issue 5, Page(s) 571–582

Abstract: Objective: To determine the ability of clinical measures of balance to distinguish fallers from non-fallers and to determine their predictive validity in identifying those at risk of falls.: Data sources: AMED, CINAHL, Medline, Scopus, PubMed Central ...

Abstract	Objective: To determine the ability of clinical measures of balance to distinguish fallers from non-fallers and to determine their predictive validity in identifying those at risk of falls. Data sources: AMED, CINAHL, Medline, Scopus, PubMed Central and Google Scholar. First search: July 2015. Final search: October 2017. Review methods: Inclusion criteria were studies of adults with a definite multiple sclerosis diagnosis, a clinical balance assessment and method of falls recording. Data were extracted independently by two reviewers. Study quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 scale and the modified Newcastle-Ottawa Quality Assessment Scale. Statistical analysis was conducted for the cross-sectional studies using Review Manager 5. The mean difference with 95% confidence interval in balance outcomes between fallers and non-fallers was used as the mode of analysis. Results: We included 33 studies (19 cross-sectional, 5 randomised controlled trials, 9 prospective) with a total of 3901 participants, of which 1917 (49%) were classified as fallers. The balance measures most commonly reported were the Berg Balance Scale, Timed Up and Go and Falls Efficacy Scale International. Meta-analysis demonstrated fallers perform significantly worse than non-fallers on all measures analysed except the Timed Up and Go Cognitive ( p < 0.05), but discriminative ability of the measures is commonly not reported. Of those reported, the Activities-specific Balance Confidence Scale had the highest area under the receiver operating characteristic curve value (0.92), but without reporting corresponding measures of clinical utility. Conclusion: Clinical measures of balance differ significantly between fallers and non-fallers but have poor predictive ability for falls risk in people with multiple sclerosis.
MeSH term(s)	Accidental Falls/prevention & control ; Disability Evaluation ; Exercise Test ; Humans ; Multiple Sclerosis/physiopathology ; Postural Balance/physiology ; Risk Assessment
Language	English
Publishing date	2017-12-20
Publishing country	England
Document type	Journal Article ; Meta-Analysis ; Systematic Review
ZDB-ID	639276-3
ISSN	1477-0873 ; 0269-2155
ISSN (online)	1477-0873
ISSN	0269-2155
DOI	10.1177/0269215517748714
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Postural control deficits in people with Multiple Sclerosis: A systematic review and meta-analysis.

Comber, Laura / Sosnoff, Jacob J / Galvin, Rose / Coote, Susan

Gait & posture

2018 Volume 61, Page(s) 445–452

Abstract: Background: Multiple sclerosis (MS) is a neurological condition that can affect the postural stability of the individual and predispose falls in this population.: Methods: A systematic literature search identified case-control studies investigating ... ...

Abstract	Background: Multiple sclerosis (MS) is a neurological condition that can affect the postural stability of the individual and predispose falls in this population. Methods: A systematic literature search identified case-control studies investigating differences in postural control across a diversity of task conditions, with the exception of gait, between people with MS and healthy controls. Meta-analysis was conducted where a variable was presented by four or more studies. Results: Forty-three studies of people with a mean Expanded Disability Status Scale (EDSS) of 1.0 to 6.0 were included. Seven conditions of assessment and 105 individual measurement variables relating to postural control were included. Quiet stance was the only condition (11 studies) possessing sufficient data to contribute to meta-analysis in terms of centre of pressure path length (SMD = 1.04, 95% CI {0.86-1.22}, p < 0.001), medio-lateral velocity (SMD = 1.35, 95% CI {0.77-1.92}, p < 0.001) and 95% confidence ellipse (SMD = 0.83 95% CI {0.59-1.08}, p < 0.001). Results: indicate that regardless of task complexity or sensory condition, people with MS display considerable deficits in postural control in comparison to healthy controls. Conclusions: The large number of variables and lack of standardisation of reporting makes data synthesis challenging, however, people with MS display considerable deficits in postural control compared to healthy controls regardless of task condition or complexity.
MeSH term(s)	Accidental Falls/statistics & numerical data ; Adult ; Case-Control Studies ; Female ; Gait/physiology ; Gait Disorders, Neurologic/etiology ; Humans ; Male ; Middle Aged ; Multiple Sclerosis/complications ; Postural Balance/physiology ; Sensation Disorders
Language	English
Publishing date	2018-02-19
Publishing country	England
Document type	Journal Article ; Meta-Analysis ; Research Support, Non-U.S. Gov't ; Review ; Systematic Review
ZDB-ID	1162323-8
ISSN	1879-2219 ; 0966-6362
ISSN (online)	1879-2219
ISSN	0966-6362
DOI	10.1016/j.gaitpost.2018.02.018
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