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Understanding whether and how FoF affects activities and participation is crucial for developing effective rehabilitation programs in individuals with MS.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To examine the relationship between measures of FoF (degree of FoF and avoidance behavior due to FoF) and measures of activities and participation in ambulatory individuals with MS. We also aim to investigate whether avoidance behavior due to FoF is relevant beyond the effect of degree of FoF.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Cross\u2010sectional survey\u2010based design.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Community.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>A convenience sample of 531 community\u2010dwelling ambulatory individuals with MS.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Interventions<\/jats:title>\n                    <jats:p>N\/A.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Main Outcome Measures<\/jats:title>\n                    <jats:p>Activities measures included Patient\u2010Reported Outcomes Measurement Information System (PROMIS) physical functioning and self\u2010efficacy to manage activities of daily living (ADLs). Measures of participation included PROMIS ability to participate in social roles and activities (SRAs) and Community Participation Indicators\u2013Control subscale.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      After controlling for age, gender, duration of MS, disability level, history of previous falls, and MS subtype, hierarchical linear regression analyses indicated participants with moderate and high FoF showed lower physical functioning and ability to participate in SRAs (\n                      <jats:italic>B<\/jats:italic>\n                      = \u22124.75 to \u221210.81,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u2009.01) compared to those with low FoF. Participants with high FoF also had reduced self\u2010efficacy in managing ADLs (\n                      <jats:italic>B<\/jats:italic>\n                      = \u22126.29,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u2009.01) and less control over community participation (\n                      <jats:italic>B<\/jats:italic>\n                      =\u20096.77,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt; .05) compared to those with low FoF. Avoidance behavior due to FoF was associated with lower self\u2010efficacy to manage ADLs (\n                      <jats:italic>\u0392<\/jats:italic>\n                      = \u22121.59,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u2009.01), ability to participate in SRAs (\n                      <jats:italic>\u0392<\/jats:italic>\n                      = \u22122.62,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u2009.01), and control over community participation (\n                      <jats:italic>\u0392<\/jats:italic>\n                      =\u20093.34,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u2009.01).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>FoF is a significant predictor of activities performance and participation in individuals with MS. Our findings highlight the importance of assessing avoidance behavior due to FoF to inform rehabilitation approaches aimed at improving the participation and community integration of individuals with MS.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/pmrj.70131","type":"journal-article","created":{"date-parts":[[2026,4,16]],"date-time":"2026-04-16T04:14:19Z","timestamp":1776312859000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Fear of falling is associated with physical functioning, activity performance, and participation in individuals with multiple sclerosis"],"prefix":"10.1002","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6404-7623","authenticated-orcid":false,"given":"Libak","family":"Abou","sequence":"first","affiliation":[{"name":"Department of Physical Medicine &amp; Rehabilitation, Michigan Medicine University of Michigan  Ann Arbor Michigan 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