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.

Background: Approximately 56% of people with multiple sclerosis (pwMS) will fall in any three-month period with the potential for physical, psychological and social consequences. Falls prevention research for pwMS 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. Methods: This paper aims to describe how the development of “Better Balance,” a complex multicomponent falls prevention intervention for pwMS, was guided by the Medical Research Council framework for the development of complex interventions. Sources of information included existing literature, original research, clinician interviews and views of pwMS. These sources were synthesized and refined through an iterative process of intervention development involving researchers, clinicians and pwMS. Results: The resulting intervention is outlined through a number of key tasks supplementing the original Medical Research Council framework. The utilization 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 pwMS. Conclusions: The articulation of the systematic process used to develop Better Balance will inform the future evaluation and usability of the intervention.