{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T16:11:29Z","timestamp":1781626289340,"version":"3.54.5"},"reference-count":52,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2024,11,28]],"date-time":"2024-11-28T00:00:00Z","timestamp":1732752000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"NIH","award":["F31HD116491"],"award-info":[{"award-number":["F31HD116491"]}]},{"name":"NIH","award":["R21HD106133"],"award-info":[{"award-number":["R21HD106133"]}]},{"name":"NIH","award":["MB-2107-38295"],"award-info":[{"award-number":["MB-2107-38295"]}]},{"DOI":"10.13039\/100000890","name":"National Multiple Sclerosis Society","doi-asserted-by":"publisher","award":["F31HD116491"],"award-info":[{"award-number":["F31HD116491"]}],"id":[{"id":"10.13039\/100000890","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000890","name":"National Multiple Sclerosis Society","doi-asserted-by":"publisher","award":["R21HD106133"],"award-info":[{"award-number":["R21HD106133"]}],"id":[{"id":"10.13039\/100000890","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000890","name":"National Multiple Sclerosis Society","doi-asserted-by":"publisher","award":["MB-2107-38295"],"award-info":[{"award-number":["MB-2107-38295"]}],"id":[{"id":"10.13039\/100000890","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Brain Sciences"],"abstract":"<jats:p>Purpose: Persons with multiple sclerosis (MS) experience changes in balance, such as poor and reactive stepping, as well as altered fall-related psychological factors, such as increased concern about falling and feared consequences about falling. Such concerns and fear may relate to and influence mobility. However, these relations are poorly understood in people with MS. This study aimed to investigate the relation between reactive stepping performance and fall-related psychological factors, as well as to assess how these relations differ between individuals who have and have not fallen. Methods: In a single session, participants completed measures regarding fall-related psychological factors (balance confidence, concern about falling, and feared consequences of falling) and completed reactive stepping tasks. Following the visit, participants completed weekly surveys for 3 months to report their falls. Spearman rho correlations were computed to examine associations between participants\u2019 reactive stepping performance and their fall-related concerns, confidence, and consequences, with a stratified analysis to compare these associations between fallers and non-fallers. Results: 44 individuals with MS participated in our study, with 27 individuals experiencing 0 falls (non-fallers) and 17 individuals experiencing at least 1 fall (fallers) in the 3-month follow-up period. Better reactive stepping performance was correlated with fewer concerns, greater confidence, and lower feared consequences related to falling. The stratified analysis revealed a greater number of significant associations for non-fallers than fallers, although the small sample of fallers reduced our ability to detect a relationship in this group. Conclusions: Reactive stepping was associated with fall-related psychological factors. Interventions targeting reactive stepping may be beneficial in enhancing fall-related psychological well-being in the MS community.<\/jats:p>","DOI":"10.3390\/brainsci14121197","type":"journal-article","created":{"date-parts":[[2024,11,28]],"date-time":"2024-11-28T03:21:23Z","timestamp":1732764083000},"page":"1197","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["The Relation Among Reactive Stepping and Fall-Related Psychological Factors in Multiple Sclerosis"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6546-5752","authenticated-orcid":false,"given":"Taylor N.","family":"Takla","sequence":"first","affiliation":[{"name":"Neuroimaging and Neurorehabilitation Laboratory, Wayne State University, Detroit, MI 48201, USA"},{"name":"Translational Neuroscience Program, Wayne State University, Detroit, MI 48201, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-1151-7000","authenticated-orcid":false,"given":"Patrick G.","family":"Monaghan","sequence":"additional","affiliation":[{"name":"Neuroimaging and Neurorehabilitation Laboratory, Wayne State University, Detroit, MI 48201, USA"},{"name":"Department of Health Care Sciences, Wayne State University, Detroit, MI 48201, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel S.","family":"Peterson","sequence":"additional","affiliation":[{"name":"College of Health Solutions, Arizona State University, Phoenix, AZ 85004, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4548-1077","authenticated-orcid":false,"given":"Nora E.","family":"Fritz","sequence":"additional","affiliation":[{"name":"Neuroimaging and Neurorehabilitation Laboratory, Wayne State University, Detroit, MI 48201, USA"},{"name":"Translational Neuroscience Program, Wayne State University, Detroit, MI 48201, USA"},{"name":"Department of Health Care Sciences, Wayne State University, Detroit, MI 48201, USA"},{"name":"Department of Neurology, Wayne State University, Detroit, MI 48201, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,11,28]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"271","DOI":"10.1097\/00019052-200106000-00003","article-title":"Axonal and Neuronal Degeneration in Multiple Sclerosis: Mechanisms and Functional Consequences","volume":"14","author":"Bjartmar","year":"2001","journal-title":"Curr. Opin. Neurol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"e1029","DOI":"10.1212\/WNL.0000000000007035","article-title":"The Prevalence of MS in the United States: A Population-Based Estimate Using Health Claims Data","volume":"92","author":"Wallin","year":"2019","journal-title":"Neurology"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"189","DOI":"10.2165\/11591150-000000000-00000","article-title":"Impact of Walking Impairment in Multiple Sclerosis: Perspectives of Patients and Care Partners","volume":"4","author":"LaRocca","year":"2011","journal-title":"Patient"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"247","DOI":"10.7224\/1537-2073.2020-014","article-title":"Falls in People with Multiple Sclerosis: Risk Identification, Intervention, and Future Directions","volume":"22","author":"Coote","year":"2020","journal-title":"Int. J. MS Care"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"717","DOI":"10.1016\/j.apmr.2023.11.011","article-title":"Examination of Risk Factors Associated With Falls and Injurious Falls in People with Multiple Sclerosis: An Updated Nationwide Study","volume":"105","author":"Abou","year":"2024","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"102609","DOI":"10.1016\/j.msard.2020.102609","article-title":"Fear of Falling and Falls in People with Multiple Sclerosis: A Literature Review","volume":"47","author":"Scholz","year":"2021","journal-title":"Mult. Scler. Relat. Disord."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1253","DOI":"10.2522\/ptj.20100304","article-title":"Development of a Scale to Assess Avoidance Behavior Due to a Fear of Falling: The Fear of Falling Avoidance Behavior Questionnaire","volume":"91","author":"Landers","year":"2011","journal-title":"Phys. Ther."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"368","DOI":"10.1093\/ageing\/afh106","article-title":"Fear-Related Avoidance of Activities, Falls and Physical Frailty. A Prospective Community-Based Cohort Study","volume":"33","author":"Delbaere","year":"2004","journal-title":"Age Ageing"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1031","DOI":"10.1016\/j.apmr.2007.10.043","article-title":"Injurious Falls Among Middle Aged and Older Adults with Multiple Sclerosis","volume":"89","author":"Peterson","year":"2008","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1016\/j.gaitpost.2018.06.174","article-title":"Fear of Falling, Not Falls, Impacts Leisure-Time Physical Activity in People with Multiple Sclerosis","volume":"65","author":"Kalron","year":"2018","journal-title":"Gait Posture"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"48","DOI":"10.1109\/MEMB.2003.1195695","article-title":"Strategies for Dynamic Stability During Adaptive Human Locomotion","volume":"22","author":"Patla","year":"2003","journal-title":"IEEE Eng. Med. Biol. Mag."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1390","DOI":"10.1016\/j.apmr.2014.01.004","article-title":"Postural Response Latencies Are Related to Balance Control during Standing and Walking in Patients with Multiple Sclerosis","volume":"95","author":"Huisinga","year":"2014","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"113","DOI":"10.1080\/08990220802131127","article-title":"Imbalance in Multiple Sclerosis: A Result of Slowed Spinal Somatosensory Conduction","volume":"25","author":"Cameron","year":"2008","journal-title":"Somatosens. Mot. Res."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"513","DOI":"10.1016\/j.apmr.2015.10.103","article-title":"Characterization of Compensatory Stepping in People with Multiple Sclerosis","volume":"97","author":"Peterson","year":"2016","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1016\/j.msard.2019.01.054","article-title":"Protective Stepping in Multiple Sclerosis: Impacts of a Single Session of in-Place Perturbation Practice","volume":"30","author":"Dibble","year":"2019","journal-title":"Mult. Scler. Relat. Disord."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"3649","DOI":"10.1080\/09638288.2022.2138570","article-title":"Perturbation-Based Balance Training to Improve Postural Responses and Falls in People with Multiple Sclerosis: A Randomized Controlled Trial","volume":"45","author":"Monjezi","year":"2023","journal-title":"Disabil. Rehabil."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"104607","DOI":"10.1016\/j.msard.2023.104607","article-title":"Training Reactive Balance Using Trips and Slips in People with Multiple Sclerosis: A Blinded Randomised Controlled Trial","volume":"73","author":"Okubo","year":"2023","journal-title":"Mult. Scler. Relat. Disord."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"pzac041","DOI":"10.1093\/ptj\/pzac041","article-title":"Examining the Relationship Between Reactive Stepping Outcomes and Falls in People with Multiple Sclerosis","volume":"102","author":"Monaghan","year":"2022","journal-title":"Phys. Ther."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1518","DOI":"10.1007\/s00415-016-8158-4","article-title":"Postural Motor Learning in People with Parkinson\u2019s Disease","volume":"263","author":"Peterson","year":"2016","journal-title":"J. Neurol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"807","DOI":"10.1093\/gerona\/glp027","article-title":"Impaired Reactive Stepping Adjustments in Older Adults","volume":"64","author":"Tseng","year":"2009","journal-title":"J. Gerontol. Ser. A Biol. Sci. Med. Sci."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"698","DOI":"10.1093\/ptj\/pzx044","article-title":"Fear of Falling in People with Multiple Sclerosis: Which Clinical Characteristics Are Important?","volume":"97","author":"Khalil","year":"2017","journal-title":"Phys. Ther."},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Takla, T.N., Matsuda, P.N., Herring, T.E., Daugherty, A.M., and Fritz, N.E. (2024). Scale Development to Evaluate Differences between Concern about Falling and Fear of Falling: The Concern and Fear of Falling Evaluation. Front. Psychol., 15.","DOI":"10.3389\/fpsyg.2024.1336078"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"105506","DOI":"10.1016\/j.msard.2024.105506","article-title":"Fear of Falling and Common Symptoms of Multiple Sclerosis: Physical Function, Cognition, Fatigue, Depression, and Sleep\u2014A Systematic Review","volume":"84","author":"Abou","year":"2024","journal-title":"Mult. Scler. Relat. Disord."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"169","DOI":"10.5014\/ajot.2012.002535","article-title":"Fear of Falling and Its Relationship with Anxiety, Depression, and Activity Engagement among Community-Dwelling Older Adults","volume":"66","author":"Painter","year":"2012","journal-title":"Am. J. Occup. Ther."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"198","DOI":"10.1097\/NPT.0000000000000490","article-title":"Motor and Non-Motor Factors of Concern About Falling and Fear of Falling in Multiple Sclerosis","volume":"48","author":"Takla","year":"2024","journal-title":"J. Neurol. Phys. Ther."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1329","DOI":"10.1046\/j.1532-5415.2002.50352.x","article-title":"Falls and Fear of Falling: Which Comes First? A Longitudinal Prediction Model Suggests Strategies for Primary and Secondary Prevention","volume":"50","author":"Friedman","year":"2002","journal-title":"J. Am. Geriatr. Soc."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"164","DOI":"10.7224\/1537-2073.2014-042","article-title":"Fear of Falling Is Associated with Recurrent Falls in People with Multiple Sclerosis","volume":"17","author":"Mazumder","year":"2015","journal-title":"Int. J. MS Care"},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Kalron, A. (2014). The Relationship between Specific Cognitive Domains, Fear of Falling, and Falls in People with Multiple Sclerosis. Biomed. Res. Int., 2014.","DOI":"10.1155\/2014\/281760"},{"key":"ref_29","first-page":"1974","article-title":"The Effect of Balance, Walking Capacity, and Fear of Falling on the Level of Community Integration in Individuals with Multiple Sclerosis: A Cross-Sectional Study","volume":"40","year":"2023","journal-title":"Physiother. Theory Pract."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"501","DOI":"10.1007\/s004210100437","article-title":"Relationship between Fear of Falling and Balancing Ability during Abrupt Deceleration in Aged Women Having Similar Habitual Physical Activities","volume":"85","author":"Okada","year":"2001","journal-title":"Eur. J. Appl. Physiol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"3255","DOI":"10.1152\/jn.01139.2003","article-title":"Influence of Postural Anxiety on Postural Reactions to Multi-Directional Surface Rotations","volume":"92","author":"Carpenter","year":"2004","journal-title":"J. Neurophysiol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"292","DOI":"10.1002\/ana.22366","article-title":"Diagnostic Criteria for Multiple Sclerosis: 2010 Revisions to the McDonald Criteria","volume":"69","author":"Polman","year":"2011","journal-title":"Ann. Neurol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"349","DOI":"10.1177\/135245859900500508","article-title":"Disease Steps in Multiple Sclerosis: A Longitudinal Study Comparing Disease Steps and EDSS to Evaluate Disease Progression","volume":"5","author":"Hohol","year":"1999","journal-title":"Mult. Scler."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"103962","DOI":"10.1016\/j.msard.2022.103962","article-title":"Prediction of Future Falls among Full-Time Wheelchair and Scooter Users with Multiple Sclerosis: A Prospective Study","volume":"64","author":"Abou","year":"2022","journal-title":"Mult. Scler. Relat. Disord."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"259","DOI":"10.1177\/0269215508095087","article-title":"Predicting Accidental Falls in People with Multiple Sclerosis\u2014A Longitudinal Study","volume":"23","author":"Lundholm","year":"2009","journal-title":"Clin. Rehabil."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"614","DOI":"10.1093\/ageing\/afi196","article-title":"Development and Initial Validation of the Falls Efficacy Scale-International (FES-I)","volume":"34","author":"Yardley","year":"2005","journal-title":"Age Ageing"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"883","DOI":"10.1016\/j.apmr.2012.10.034","article-title":"Falls Efficacy Scale-International: A Cross-Sectional Validation in People with Multiple Sclerosis","volume":"94","author":"Hoang","year":"2013","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_38","first-page":"613925","article-title":"Activities-Specific Balance Confidence in People with Multiple Sclerosis","volume":"2012","author":"Carling","year":"2012","journal-title":"Mult. Scler. Int."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1093\/geront\/42.1.17","article-title":"A Prospective Study of the Relationship between Feared Consequences of Falling and Avoidance of Activity in Community-Living Older People","volume":"42","author":"Yardley","year":"2002","journal-title":"Gerontologist"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"323","DOI":"10.2340\/16501977-0537","article-title":"Using Psychometric Techniques to Improve the Balance Evaluation Systems Test: The Mini-Bestest","volume":"42","author":"Franchignoni","year":"2010","journal-title":"J. Rehabil. Med."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"1404","DOI":"10.1007\/s00415-006-0224-x","article-title":"An Alternative Clinical Postural Stability Test for Patients with Parkinson\u2019s Disease","volume":"253","author":"Jacobs","year":"2006","journal-title":"J. Neurol."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"1325","DOI":"10.1016\/j.apmr.2017.01.030","article-title":"Validity of the Instrumented Push and Release Test to Quantify Postural Responses in Persons with Multiple Sclerosis","volume":"98","author":"Peterson","year":"2017","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"39","DOI":"10.4085\/1062-6050-0231.22","article-title":"Use of Reactive Balance Assessments with Clinical Baseline Concussion Assessments in Collegiate Athletes","volume":"59","author":"Morris","year":"2024","journal-title":"J. Athl. Train."},{"key":"ref_44","doi-asserted-by":"crossref","unstructured":"Morris, A., Cassidy, B., Pelo, R., Fino, N.F., Presson, A.P., Cushman, D.M., Monson, N.E., Dibble, L.E., and Fino, P.C. (2020). Reactive Postural Responses After Mild Traumatic Brain Injury and Their Association with Musculoskeletal Injury Risk in Collegiate Athletes: A Study Protocol. Front. Sports Act. Living, 2.","DOI":"10.3389\/fspor.2020.574848"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"517","DOI":"10.1123\/jsr.2021-0229","article-title":"Interadministrator Reliability of a Modified Instrumented Push and Release Test of Reactive Balance","volume":"31","author":"Morris","year":"2022","journal-title":"J. Sport. Rehabil."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"1448","DOI":"10.2522\/ptj.20150416","article-title":"Cohort Study Comparing the Berg Balance Scale and the Mini-BESTest in People Who Have Multiple Sclerosis and Are Ambulatory","volume":"96","author":"Ross","year":"2016","journal-title":"Phys. Ther."},{"key":"ref_47","unstructured":"Cohen, J. (1988). Statistical Power Analysis for the Behavioural Sciences, Routledge. [2nd ed.]."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"103313","DOI":"10.1016\/j.msard.2021.103313","article-title":"The Relationship between Plantar Sensation and Muscle Onset during Automatic Postural Responses in People with Multiple Sclerosis and Healthy Controls","volume":"56","author":"Monaghan","year":"2021","journal-title":"Mult. Scler. Relat. Disord."},{"key":"ref_49","first-page":"105588","article-title":"Examination of Proprioceptive Reliance During Backward Walking in Individuals With Multiple Sclerosis","volume":"86","author":"VanNostrand","year":"2024","journal-title":"J. Neurol. Phys. Ther."},{"key":"ref_50","doi-asserted-by":"crossref","unstructured":"Fling, B.W., Dutta, G.G., Schlueter, H., Cameron, M.H., and Horak, F.B. (2014). Associations between Proprioceptive Neural Pathway Structural Connectivity and Balance in People with Multiple Sclerosis. Front. Hum. Neurosci., 8.","DOI":"10.3389\/fnhum.2014.00814"},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"1339","DOI":"10.1007\/s00702-007-0657-0","article-title":"Cortical Control of Postural Responses","volume":"114","author":"Jacobs","year":"2007","journal-title":"J. Neural Transm."},{"key":"ref_52","first-page":"2055217316641130","article-title":"Fall Risk in People with MS: A Physiological Profile Assessment Study","volume":"2","author":"Hoang","year":"2016","journal-title":"Mult. Scler. J. Exp. Transl. Clin."}],"container-title":["Brain Sciences"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2076-3425\/14\/12\/1197\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T16:41:14Z","timestamp":1760114474000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2076-3425\/14\/12\/1197"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,11,28]]},"references-count":52,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2024,12]]}},"alternative-id":["brainsci14121197"],"URL":"https:\/\/doi.org\/10.3390\/brainsci14121197","relation":{},"ISSN":["2076-3425"],"issn-type":[{"value":"2076-3425","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,11,28]]}}}