Podiatry Interventions to Prevent Falls in Older People

A Systematic Review and Meta-analysis

Gavin Wylie; Claire Torrens; Pauline Campbell; Helen Frost; Adam Lee Gordon; Hylton B. Menz; Dawn A. Skelton; Frank Sullivan; Miles D. Witham; Jacqui Morris

Disclosures

Age Ageing. 2019;48(3):327-336. 

In This Article

Abstract and Introduction

Abstract

Background: foot problems are independent risk factors for falls in older people. Podiatrists diagnose and treat a wide range of problems affecting the feet, ankles and lower limbs. However, the effectiveness of podiatry interventions to prevent falls in older people is unknown. This systematic review examined podiatry interventions for falls prevention delivered in the community and in care homes.

Methods: systematic review and meta-analysis. We searched multiple electronic databases with no language restrictions. Randomised or quasi-randomised-controlled trials documenting podiatry interventions in older people (aged 60+) were included. Two reviewers independently applied selection criteria and assessed methodological quality using the Cochrane Risk of Bias tool. TiDieR guidelines guided data extraction and where suitable statistical summary data were available, we combined the selected outcome data in pooled meta-analyses.

Results: from 35,857 titles and 5,201 screened abstracts, nine studies involving 6,502 participants (range 40–3,727) met the inclusion criteria. Interventions were single component podiatry (two studies), multifaceted podiatry (three studies), or multifactorial involving other components and referral to podiatry component (four studies). Seven studies were conducted in the community and two in care homes. Quality assessment showed overall low risk for selection bias, but unclear or high risk of detection bias in 4/9 studies. Combining falls rate data showed significant effects for multifaceted podiatry interventions compared to usual care (falls rate ratio 0.77 [95% CI 0.61, 0.99]); and multifactorial interventions including podiatry (falls rate ratio: 0.73 [95% CI 0.54, 0.98]). Single component podiatry interventions demonstrated no significant effects on falls rate.

Conclusions: multifaceted podiatry interventions and multifactorial interventions involving referral to podiatry produce significant reductions in falls rate. The effect of multi-component podiatry interventions and of podiatry within multifactorial interventions in care homes is unknown and requires further trial data.

PROSPERO registration number: CRD42017068300.

Introduction

Falls are common among older people in both community and care home settings, leading to injury, fear, hospitalisation, loss of function and death.[1,2] Annually, falls cost the National Health Service (NHS) in the UK more than £2 billion and in the USA, this figure is as high as $100 billion.[3,4] To date, preventative interventions have typically included strengthening and balance exercises, medication review, physiotherapy, occupational therapy, and detecting and treating visual impairment.[5]

More recently, foot problems in older people[6,7] have been shown to be associated with falls.[8,9] Foot-related risk factors include foot pain, reduced ankle joint range of motion, hallux valgus deformity (bunion), and reduced toe plantar flexor muscle strength, while footwear-related risk factors include increased heel height, the absence of a strap, lace or other retaining medium and reduced sole contact area.[8–11] These factors have led to the development of podiatry interventions to reduce falls.[12,13] Podiatrists improve mobility for patients by providing assessment, diagnosis and treatment of common and complex lower-limb pathology using a wide range of treatment modalities (manual debridement, surgical techniques, exercises, footwear and orthoses provision).[14]

Previous systematic reviews have shown encouraging effects of foot and ankle exercises alone on balance and falls. Furthermore, footwear and orthoses interventions have been shown to have a beneficial effect on balance only in community-dwelling older people.[15,16] A systematic evaluation of multifaceted podiatry intervention packages (callus debridement, exercise, footwear, orthoses) on falls or falls rate has not been undertaken.

Older people living in care homes are around three times more likely to fall compared with those living in the community, therefore understanding effective ways to reduce falls in care homes is important.[17] Evidence for reducing care home falls remains equivocal[18] and other than footwear assessment, the effects of podiatry interventions on falls have not been evaluated in this setting.

The aim of this systematic review is to determine the effectiveness of podiatry interventions for falls reduction in older adults residing in the community and in care homes.

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