A Comparison of Constructions of Spirituality in an Australian Nursing Context.

People with multiple sclerosis (PwMS) exhibit frequent and debilitating falls, yet current therapies for preventing these falls are inadequate . Although many factors contribute to fall risk, reactive balance, including the ability to take quick, protective steps after a slip or trip, is a critical mechanism of fall avoidance . Indeed, numerous studies have suggested that reactive balance is closely linked to falls in older adults . More recently, reactive balance deficits, particularly in the temporal domain, have been observed in PwMS . Therefore, understanding and addressing reactive balance deficits and factors that may influence them is crucial for developing more effective fall prevention strategies in PwMS. Affective symptoms, such as poor balance confidence or concern about falling, are common in PwMS . Although these terms are often used interchangeably, they reflect distinct yet related constructs. Balance confidence refers to a person’s belief in their ability to perform everyday activities without losing their balance or becoming unsteady . Concern about falling is defined as “a lasting feeling of dread or apprehension about situations that are believed to threaten or challenge balance” . Both balance confidence and concern about falling are strongly associated with increased fall risk in PwMS and have been shown to more accurately identify individuals at high risk of falling compared to objective performance-based measures of mobility (e.g., Timed Up and Go, Timed 25-Foot Walk Test, 2-Minute Walk Test) . Further, there is early evidence that reactive balance responses may be impacted by individuals’ affect. For example, when there is increased threat of a fall (e.g., when standing several meters above the ground), individuals exhibit alter their response to postural perturbations . Similarly, the first exposure to a perturbation, when participants are unsure of the amplitude or severity of the perturbation, often elicits a startling response , stiffening (co-contraction) of lower extremity muscles . People with increased fear of falling also exhibit increased lower extremity joint stiffening during perturbations . Finally, individuals with high concerns about falling, driven by an awareness of their increased risk for a fall, may perceive postural threats as more threatening than they actually are . This exaggerated threat perception can lead to overly cautious movements and excessive behavioral adaptations which may paradoxically increase fall risk . Taken together, this work indicates a possible relationship between reactive balance and affective symptoms. In particular, balance confidence or concern about falling, as components of previous experience, may relate to reactive postural control in a uni- or bi-directional fashion. However, there is little data directly assessing this relationship, and less still in PwMS, a population with deficits in both domains. To our knowledge, only one study has assessed such relationships in PwMS. Takla et al. 2024 investigated the relationship between affective factors and reactive stepping (collected via inertial sensors during an instrumented Push & Release test) in 44 PwMS . Results showed direct relationships between the total time to stabilization and affective symptoms. Preliminary analyses investigated the effect of fall status on these relationships, but a relatively small sample of fallers (n=17), somewhat reduced interpretability across faller and non-faller subgroups. Therefore, results need to be replicated in larger, more diverse cohorts. Identifying the functional relevance of reactive balance (i.e., its relationship to falls and concern about falling) will inform whether and how to target this movement to reduce falls in PwMS.