Abstract
Background and PurposeScreening for feet- and footwear-related influences on fall risk is an important component of multifactorial fall risk screenings, yet few evidence-based tools are available for this purpose. We developed the Screening Tool for Feet/Footwear-Related Influences on Fall Risk to support interprofessional health care providers in their efforts to screen for feet/footwear-related influences on fall risk among community-dwelling older adults identified at risk for falling.Materials and MethodsThe study consisted of two phases. During Phase 1, results of a systematic review of lower-limb factors associated with balance and falls informed tool development. The tool's initial draft was evaluated by an external group of nine interprofessional content experts. After incorporating changes recommended by Phase 1 participants, Phase 2 was initiated. During Phase 2, eight new interprofessional experts (19.3 average years of experience) completed the three rounds of a modified Delphi study.ResultsPhase 1 experts recommended modifying eight items and rated the tool's clarity, appeal and clinical feasibility as 81.2/100, 79.1/100, and 76.1/100, respectively. Phase 2 participants suggested combining items with similar recommended actions, adding a question about orthoses, and increasing the specificity of nine items. The refinements resulted in a 20-item screening tool. Each item was approved by the Phase 2 participants with > 80% agreement after two rounds of consensus voting, reflecting the tool's high face and content validity.ConclusionThe new screening tool has high face and content validity and supports identification of feet- and footwear-related influences on fall risk among community-dwelling older adults. The tool can be used by interprofessional healthcare providers completing a multifactorial fall risk screening on community-dwelling adults identified as being at risk for falling.
Highlights
The Center for Disease Control (CDC) reported 35.6 million falls among older adults in 2018 (1)
Older persons who present for fallrelated medical attention, report recurrent falls in the past year, or report difficulties with walking or balance should be identified as at-risk and have a multifactorial fall risk assessment (5)
This study aimed to use a two-phase study design to develop a tool that compliments the STEADI algorithm and supports interprofessional health care providers in their efforts to screen for feet/footwear-related influences on fall risk among community-dwelling older adults identified at risk for falling
Summary
The Center for Disease Control (CDC) reported 35.6 million falls among older adults in 2018 (1). According to Stevens and Lee (4), 9,563–45,164 medically treated falls could be prevented annually, with an associated Medicare cost reduction of US$ 94 million to US$ 442 million Together, these facts demonstrate the importance of reducing falls among older adults. The CDC algorithm assessment includes the directive to “Assess feet/footwear” (7) and general recommendations are provided in a separate document, the Coordinated Care Plan to Prevent Older Adult Falls (8). These recommendations include assessing feet for decreased sensation, presence of foot deformities, and use of footwear without good arch support, heel support, and sturdy soles with good grip (8). We developed the Screening Tool for Feet/Footwear-Related Influences on Fall Risk to support interprofessional health care providers in their efforts to screen for feet/footwear-related influences on fall risk among community-dwelling older adults identified at risk for falling
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