Effectiveness of a multifaceted podiatry intervention to prevent falls in community dwelling older people with disabling foot pain: randomised controlled trial.
journal contributionposted on 27.05.2021, 04:14 by MJ Spink, Hylton MenzHylton Menz, Mohammadreza FotoohabadiMohammadreza Fotoohabadi, E Wee, Karl LandorfKarl Landorf, KD Hill, SR Lord
To determine the effectiveness of a multifaceted podiatry intervention in preventing falls in community dwelling older people with disabling foot pain. Parallel group randomised controlled trial. University health sciences clinic in Melbourne, Australia. 305 community dwelling men and women (mean age 74 (SD 6) years) with disabling foot pain and an increased risk of falling. 153 were allocated to a multifaceted podiatry intervention and 152 to routine podiatry care, with 12 months' follow-up. Multifaceted podiatry intervention consisting of foot orthoses, advice on footwear, subsidy for footwear ($A100 voucher; £65; €74), a home based programme of foot and ankle exercises, a falls prevention education booklet, and routine podiatry care for 12 months. The control group received routine podiatry care for 12 months. Proportion of fallers and multiple fallers, falling rate, and injuries resulting from falls during follow-up. Overall, 264 falls occurred during the study. 296 participants returned all 12 calendars: 147 (96%) in the intervention group and 149 (98%) in the control group. Adherence was good, with 52% of the participants completing 75% or more of the requested three exercise sessions weekly, and 55% of those issued orthoses reporting wearing them most of the time. Participants in the intervention group (n=153) experienced 36% fewer falls than participants in the control group (incidence rate ratio 0.64, 95% confidence interval 0.45 to 0.91, P=0.01). The proportion of fallers and multiple fallers did not differ significantly between the groups (relative risk 0.85, 0.66 to 1.08, P=0.19 and 0.63, 0.38 to 1.04, P=0.07). One fracture occurred in the intervention group and seven in the control group (0.14, 0.02 to 1.15, P=0.07). Significant improvements in the intervention group compared with the control group were found for the domains of strength (ankle eversion), range of motion (ankle dorsiflexion and inversion/eversion), and balance (postural sway on the floor when barefoot and maximum balance range wearing shoes). A multifaceted podiatry intervention reduced the rate of falls in community dwelling older people with disabling foot pain. The components of the intervention are inexpensive and relatively simple to implement, suggesting that the programme could be incorporated into routine podiatry practice or multidisciplinary falls prevention clinics. Australian New Zealand Clinical Trials Registry ACTRN12608000065392.
This study was funded by the National Health and Medical Research Council of Australia and the La Trobe University central large grant scheme. HBM is currently a National Health and Medical Research Council fellow (clinical career development award, 433049). The foot orthoses in this study were provided by Foot Science International, Christchurch, New Zealand.
JournalBMJ (Clinical research ed.)
Article NumberARTN d3411
PublisherBMJ PUBLISHING GROUP
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Science & TechnologyLife Sciences & BiomedicineMedicine, General & InternalGeneral & Internal MedicineMULTIFACTORIAL INTERVENTIONEXERCISE PROGRAMRISK-FACTORSOUTDOOR FALLSANKLEWOMENPREVALENCEBALANCETESTSCAREFootHumansPainPatient CompliancePodiatryAccidental FallsAgedAged, 80 and overDisabled PersonsQueenslandFemaleMale