Podiatry interventions to prevent falls in older people

a systematic review and meta-analysis

Gavin Wylie (Lead / Corresponding author), Claire Torrens, Pauline Campbell, Helen Frost, Adam Lee Gordon, Hylton B. Menz, Dawn A. Skelton, Frank Sullivan, Miles D. Witham, Jacqui Morris

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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.

Original languageEnglish
Pages (from-to)327-336
Number of pages10
JournalAge and Ageing
Volume48
Issue number3
Early online date7 Jan 2019
DOIs
Publication statusPublished - May 2019

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Podiatry
Meta-Analysis
Home Care Services
Foot
Referral and Consultation
Selection Bias

Keywords

  • care homes
  • community dwelling
  • falls
  • older people
  • podiatry
  • systematic review

Cite this

Wylie, Gavin ; Torrens, Claire ; Campbell, Pauline ; Frost, Helen ; Gordon, Adam Lee ; Menz, Hylton B. ; Skelton, Dawn A. ; Sullivan, Frank ; Witham, Miles D. ; Morris, Jacqui. / Podiatry interventions to prevent falls in older people : a systematic review and meta-analysis. In: Age and Ageing. 2019 ; Vol. 48, No. 3. pp. 327-336.
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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.",
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Wylie, G, Torrens, C, Campbell, P, Frost, H, Gordon, AL, Menz, HB, Skelton, DA, Sullivan, F, Witham, MD & Morris, J 2019, 'Podiatry interventions to prevent falls in older people: a systematic review and meta-analysis', Age and Ageing, vol. 48, no. 3, pp. 327-336. https://doi.org/10.1093/ageing/afy189

Podiatry interventions to prevent falls in older people : a systematic review and meta-analysis. / Wylie, Gavin (Lead / Corresponding author); Torrens, Claire; Campbell, Pauline; Frost, Helen; Gordon, Adam Lee; Menz, Hylton B.; Skelton, Dawn A.; Sullivan, Frank; Witham, Miles D.; Morris, Jacqui.

In: Age and Ageing, Vol. 48, No. 3, 05.2019, p. 327-336.

Research output: Contribution to journalArticle

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T1 - Podiatry interventions to prevent falls in older people

T2 - a systematic review and meta-analysis

AU - Wylie, Gavin

AU - Torrens, Claire

AU - Campbell, Pauline

AU - Frost, Helen

AU - Gordon, Adam Lee

AU - Menz, Hylton B.

AU - Skelton, Dawn A.

AU - Sullivan, Frank

AU - Witham, Miles D.

AU - Morris, Jacqui

N1 - © The Author(s) 2019. Published by Oxford University Press on behalf of the British Geriatrics Society.

PY - 2019/5

Y1 - 2019/5

N2 - 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.

AB - 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.

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