Article

Effectiveness of a multifaceted podiatry intervention to prevent falls in community dwelling older people with disabling foot pain: randomised controlled trial

Musculoskeletal Research Centre, Faculty of Health Sciences, La Trobe University, Bundoora Victoria, Australia.
BMJ (online) (Impact Factor: 17.45). 06/2011; 342(jun16 3):d3411. DOI: 10.1136/bmj.d3411
Source: PubMed

ABSTRACT

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.

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    • "monthly calendar of falls Smulders et al. 15 (2010) Hospital 96 IG% showed fewer falls and improved balance confidence more than CG. monthly calendar of falls Spink et al. 13 (2011) Community 305 IG showed fewer falls, better MS, better ROM, and better balance than CG. monthly calendar of falls Shumway-Cook et al. 17 (2007) Community 53 IG showed the lowest% of falls, better balance, better MS for the lower limbs and better mobility than CG. "

    Full-text · Dataset · Dec 2014
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    • "The contribution of footwear to falls has in part been demonstrated by work that showed an association between indoor falls of older adults and lack of shoe use indoors, suggesting that shoes may help prevent falls (Menz et al., 2006b). Previous research has shown that a multifaceted podiatric intervention utilizing home based foot and ankle exercises , assistance with the purchase of safe footwear, and provision of prefabricated foot orthoses can reduce the rate of falls in older people with disabling foot pain (Spink et al., 2011). Foot problems, loss of proprioception and decreases in ankle strength and range of motion associated with aging have been tied to deteriorations in balance and increased fall risk (Anon, 2011b; Bok et al., 2013). "

    Full-text · Dataset · Dec 2014
  • Source
    • "The contribution of footwear to falls has in part been demonstrated by work that showed an association between indoor falls of older adults and lack of shoe use indoors, suggesting that shoes may help prevent falls (Menz et al., 2006b). Previous research has shown that a multifaceted podiatric intervention utilizing home based foot and ankle exercises , assistance with the purchase of safe footwear, and provision of prefabricated foot orthoses can reduce the rate of falls in older people with disabling foot pain (Spink et al., 2011). Foot problems, loss of proprioception and decreases in ankle strength and range of motion associated with aging have been tied to deteriorations in balance and increased fall risk (Anon, 2011b; Bok et al., 2013). "
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    ABSTRACT: Foot and ankle problems are highly prevalent fall risks in the elderly. Ankle foot orthoses designed to stabilize the foot and ankles have been studied within specific patient groups, but their efficacy with a less restrictive elderly population is unknown. This study investigated if custom-made ankle foot orthoses improve postural stability in older adults.Methods Thirty ambulatory older adults averaged 73 (standard deviation = 6.5) years completed Romberg's balance (eyes-open/eyes-closed), functional reach, and Timed Up and Go tests while wearing validated kinematic sensors. Each test was completed in standardized shoes with and without bilateral orthoses. Additionally, barefoot trials were conducted for the Romberg's and functional reach tests.FindingsCompared to the barefoot and ‘shoes alone’ conditions, the orthoses reduced center of mass sway on average by 49.0% (P = 0.087) and 40.7% (P = 0.005) during eyes-open balance trials. The reduction was amplified during the eyes-closed trials with average reductions of 65.9% (P = 0.000) and 47.8% (P = 0.004), compared to barefoot and ‘shoes alone’ conditions. The orthoses did not limit functional reach distance nor timed-up and go completion times. However, the medial-lateral postural coordination while reaching was improved significantly with orthoses compared to barefoot (14.3%; P = 0.030) and ‘shoes alone’ (13.5%; P = 0.039) conditions.InterpretationAnkle foot orthoses reduced postural sway and improved lower extremity coordination in the elderly participants without limiting their ability to perform a standard activity of daily living. Additional studies are required to determine if these benefits are retained and subsequently translate into fewer falls.
    Full-text · Article · Oct 2014 · Clinical Biomechanics
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