Relationship between Multiple Sclerosis Severity and Fear of Falling with Mediating Roles of Disability, Cognitive Factors, and Physical Factors among Patients with MS

Background: Fear of falling (FOF) is a permanent concern and may limit daily activities and diminish confidence in balance abilities, leading to muscular deterioration, sedentary lifestyle, and reduced quality of life. The present study aimed to investigate the relationship between multiple sclerosis severity and FOF with mediating roles of disability, cognitive factors, and physical factors among patients with MS. Methods: This was a correlational study based on path analysis. The statistical population consisted of all patients with MS who visited the neurology centers of hospitals in Sari, Iran, 200 of whom were selected as the sample using multistage random sampling. Two hospitals were selected from the hospitals of Sari city and the research sample was selected from the neurology centers of these hospitals. The research instruments included the Falls Efficacy Scale-International (FES-I), MS Severity Scale, the Expanded Disability Status Scale (EDSS), the Cognitive Factors Questionnaire, and the MOS 36-item Short-Form Health Survey (SF-36). The data were analyzed by using structural equation modeling (SEM) in SPSS AMOS-25. Results: The SEM results demonstrated that the proposed model fitted the data. FOF was found to have positive, significant relationships with MS severity and disability. MS severity and FOF had negative, significant relationships with physical factors (P<0.01). The direct relationship between MS severity and cognitive factors was insignificant and excluded from the model. The study findings confirmed the relationship between MS severity and FOF mediated by disability and physical factors in patients with MS (P<0.01). Conclusions: The frequency of FOF was found to be much higher among patients with higher MS severity. Considering the consequences of the FOF among patients with MS, it is recommended that consultation services be provided to patients with MS at healthcare centers to improve their health and activity and reduce their FOF.