Abstract
BACKGROUND: Concern about falling (CAF) is common in multiple sclerosis (MS) and affects mobility and activity, even without a history of a falls. OBJECTIVES: This study aimed to assess how avoidance behavior contributes to CAF-related mobility impairments and whether this association is consistent for fallers and non-fallers. METHODS: Participants completed questionnaires regarding CAF, avoidance behavior, and self-reported walking impairment, and laboratory walking and balance assessments. Applied structural equation modeling tested a hypothesized mediation model in which the relationship between CAF and mobility impairments would be partially mediated by avoidance behavior. Walking and balance assessments were used to construct a mobility latent factor. The model was subsequently stratified by fallers and non-fallers. RESULTS: Participants included 52 individuals with MS. 46.96 % of the significant total effect of CAF on mobility was accounted for by avoidance behaviors. No significant differences were found between fallers and non-fallers, suggesting a consistent mediation effect across both groups. CONCLUSIONS: Our findings underscore the role of avoidance behavior in partially accounting for the effects of CAF on mobility deficits among persons with MS. This effect was statistically equivalent across fall status, highlighting the pervasive impact of avoidance behavior on mobility impairments in MS.