Adaptive or Maladaptive Fear of Falling in Multiple Sclerosis: What Are We Overlooking?

Fear of falling is a common and distressing concern among people with multiple sclerosis due to the gait and balance impairments associated with the disease. Clinicians and researchers often assume that the degree of fear of falling, typically measured with the Falls Efficacy Scale International (FES-I), is proportional to activity restrictions or rehabilitation engagement. However, a low or high level of fear of falling alone does not indicate whether fear of falling influences individual's performance of daily living activities. Fear of falling can either be adaptive (when aligned with functional capacity and actual fall risk) or maladaptive (when disproportionate to functional capacity and actual fall risk). In this personal viewpoint, I discuss the importance of contextualizing fear of falling assessment within the performance of daily living activities and propose that a function-focused assessment of fear of falling may enhance our understanding of whether it is adaptive or maladaptive. This approach may also provide targeted information to guide the development of interventions to address fear of falling in people with multiple sclerosis, help identify who requires intervention, and the type of intervention needed.