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Podiatry interventions to reduce falls in older people

A systematic review

Aim(s):

To undertake a systematic review and relevant meta-analyses to determine the most effective podiatry interventions for prevention of falls in older people.

Summary:

We systematically searched MEDLINE, AMED, EMBASE, CINAHL, PEDro, Cochrane Central Register of Controlled Trials, CDSR, DARE, HTA, ZETOC, WHO ICTRP, EThOS and Google Scholar (from inception to 30 March 2017, with no language restrictions). We hand-searched reference lists and contacted experts. We included all RCTs or quasi-RCT studies that documented podiatry interventions in older people (aged 60+). Two reviewers independently applied selection criteria and assessed methodological quality using the Cochrane risk of bias tool. Data were extracted in accordance with TiDieR guidelines and tabulated and summarised in a narrative format.

We identified 32717 titles and screened 3118 abstracts for eligibility. Nine studies met our inclusion criteria, trials generally were judged as the potentially low risk of bias. The total sample size was 6518, range 40-3727 participants. Most podiatry interventions were multi-faceted although 2 were single component interventions (e.g. insoles or footwear). The majority of interventions were conducted with older people in the community (n=5). Five trials reported beneficial effects on falls rate (n=1) and falls risk (e.g. proportion of fallers, balance, foot pain) (n=4) and improvements in fall-related consequences (n=1).

Outcomes/Impact:

This is the first study to synthesise the available evidence of podiatry interventions for falls prevention in older people living in care homes or in the community. The evidence is limited, in particular in care homes, however, there is some indication that that multifaceted/ multiple component interventions have the potential to be successful in falls prevention. Meta-analysis is ongoing and the outcomes will be refined once that is complete.

This study will inform the development of an application to NIHR HTA for a future definitive trial of a podiatry intervention to prevent falls in care homes.

Principal Investigator: Dr Pauline Campbell

External Collaborators: Frost H - University of Stirling, Witham M - University of Dundee, Wylie G - University of Dundee

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