Abstract
BackgroundDespite emerging evidence that foot problems and inappropriate footwear increase the risk of falls, there is little evidence as to whether foot-related intervention strategies can be successfully implemented. The aim of this study was to evaluate adherence rates, barriers to adherence, and the predictors of adherence to a multifaceted podiatry intervention for the prevention of falls in older people.MethodsThe intervention group (n = 153, mean age 74.2 years) of a randomised trial that investigated the effectiveness of a multifaceted podiatry intervention to prevent falls was assessed for adherence to the three components of the intervention: (i) foot orthoses, (ii) footwear advice and footwear cost subsidy, and (iii) a home-based foot and ankle exercise program. Adherence to each component and the barriers to adherence were documented, and separate discriminant function analyses were undertaken to identify factors that were significantly and independently associated with adherence to the three intervention components.ResultsAdherence to the three components of the intervention was as follows: foot orthoses (69%), footwear (54%) and home-based exercise (72%). Discriminant function analyses identified that being younger was the best predictor of orthoses use, higher physical health status and lower fear of falling were independent predictors of footwear adherence, and higher physical health status was the best predictor of exercise adherence. The predictive accuracy of these models was only modest, with 62 to 71% of participants correctly classified.ConclusionsAdherence to a multifaceted podiatry intervention in this trial ranged from 54 to 72%. People with better physical health, less fear of falling and a younger age exhibited greater adherence, suggesting that strategies need to be developed to enhance adherence in frailer older people who are most at risk of falling.Trial registrationAustralian New Zealand Clinical Trials Registry ACTRN12608000065392.
Highlights
Despite emerging evidence that foot problems and inappropriate footwear increase the risk of falls, there is little evidence as to whether foot-related intervention strategies can be successfully implemented
In response to emerging evidence that foot problems [13] and inappropriate footwear [14] increase the risk of falls, we recently completed a randomised trial which found that a multifaceted podiatry intervention was effective in reducing the rate of falls by 36% in communitydwelling older people with disabling foot pain [15]
The data used in this study were collected during a randomised trial of a multifaceted podiatry intervention to prevent falls in older people, the details of which have been reported elsewhere [15,16]
Summary
Despite emerging evidence that foot problems and inappropriate footwear increase the risk of falls, there is little evidence as to whether foot-related intervention strategies can be successfully implemented. In response to emerging evidence that foot problems [13] and inappropriate footwear [14] increase the risk of falls, we recently completed a randomised trial which found that a multifaceted podiatry intervention was effective in reducing the rate of falls by 36% in communitydwelling older people with disabling foot pain [15]. This trial used three main interventions: (i) foot orthoses, (ii) footwear advice and footwear cost subsidy and (iii) home-based foot and ankle exercises. We aimed to determine the most effective way to translate the findings of our falls trial into clinical practice
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