Effectiveness of Foot and Ankle Exercise Programs on Reducing the Risk of Falling in Older Adults

Schwenk, Michael; Jordan, Elise De Haven; Honarvararaghi, Bahareh; Mohler, Jane; Armstrong, David G.; Najafi, Bijan

doi:10.7547/1030534

Cited by 33 publications

(32 citation statements)

References 54 publications

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“…The variables included in the final model are supported by previous literature, which has found ankle dorsiflexion to be important for balance and demonstrated a significant relationship between greater knee and ankle strength and higher dynamic postural stability in the elderly. 20,21,30 It is interesting to note that, individually, each independent variable failed to predict dynamic postural stability, but the combination of variables identified by the final model explains a small amount of the variance in the DPSI score when considered in combination. No single measure from the current data set predicts dynamic postural stability, but there may be a single measure not captured in this study.…”

Section: Discussionmentioning

confidence: 99%

“…Based on previous literature, we believed it would be important to include ankle range of motion because ankle dorsiflexion is a risk factor for ankle sprains, 6,19 and improving ankle range of motion and strength decreased risk of falling in older adults. 20 In addition, knee-extensor strength has been found to be a significant predictor of static and dynamic balance in the elderly. 21 Literature on trunk strength indicates that trunkextensor-muscle performance (strength and endurance) is associated with static-balance scores in elderly individuals with limited mobility, 22 and that core-strengthening programs improve static postural stability, 23 as well as dynamic postural stability measured with the SEBT.…”

mentioning

confidence: 99%

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Prediction of Dynamic Postural Stability During Single-Leg Jump Landings by Ankle and Knee Flexibility and Strength

Williams¹,

Nagai²,

Sell³

et al. 2016

Journal of Sport Rehabilitation

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Context: Dynamic postural stability is important for injury prevention, but little is known about how lower-extremity musculoskeletal characteristics (range of motion [ROM] and strength) contribute to dynamic postural stability. Knowing which modifiable physical characteristics predict dynamic postural stability can help direct rehabilitation and injuryprevention programs. Objective: To determine if trunk, hip, knee, and ankle flexibility and strength variables are significant predictors of dynamic postural stability during single-leg jump landings. Design: Cross-sectional study. Setting: Laboratory. Participants: 94 male soldiers (age 28.2 ± 6.2 y, height 176.5 ± 2.6 cm, weight 83.7 ± 26.0 kg). Intervention: None. Main Outcome Measures: Ankle-dorsiflexion and plantar-flexion ROM were assessed with a goniometer. Trunk, hip, knee, and ankle strength were assessed with an isokinetic dynamometer or handheld dynamometer. The Dynamic Postural Stability Index (DPSI) was used to quantify postural stability. Simple linear and backward stepwise-regression analyses were used to identify which physical characteristic variables were significant predictors of DPSI. Results: Simple linear-regression analysis revealed that individually, no variables were significant predictors of the DPSI. Stepwise backward-regression analysis revealed that ankle-dorsiflexion flexibility, ankle-inversion and -eversion strength, and knee-flexion and -extension strength were significant predictors of the DPSI (R 2 = .19, P = .0016, adjusted R 2 = .15). Conclusion: Ankle-dorsiflexion ROM, ankle-inversion and -eversion strength, and knee-flexion and -extension strength were identified as significant predictors of dynamic postural stability, explaining a small amount of the variance in the DPSI.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Prediction of Dynamic Postural Stability During Single-Leg Jump Landings by Ankle and Knee Flexibility and Strength

Williams¹,

Nagai²,

Sell³

et al. 2016

Journal of Sport Rehabilitation

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“…23 A meta-analysis of eight RCTs using foot and ankle exercises noted improvements in surrogate measures of outcomes, such as balance. 19 In this discussion, we summarise our key findings, compare these with previous studies and discuss the strengths and limitations of our study.…”

Section: Qualitative Resultsmentioning

confidence: 96%

“…9,13,14 Podiatry interventions to improve balance Given the emerging evidence that foot problems and inappropriate footwear increase the risk of falling, it has been suggested that podiatry may have a role to play in falls prevention, with several guidelines recommending that older people have their feet and footwear examined by a podiatrist. 15,16 Previous studies have looked at treatments that may improve balance in older adults, such as lesion debridement, 17 foot orthoses, 18 foot and ankle exercises 19,20 and footwear advice. Lesion debridement can improve function during gait if pain is reduced, exercise programmes focus on internal strengthening and flexibility, and appropriate footwear fitted with orthotic devices can provide external support, improved kinaesthesia and improved function.…”

Section: Risk Factors For Fallingmentioning

confidence: 99%

“…As expected, the intervention improved mobility as data showed an 11% reduction in the number of participants reporting problems from baseline to 12 months in the intervention group (compared with 1% change in the usual-care group). Completed EQ-5D Missing EQ-5D Completed EQ-5D Missing EQ-5D (48) 221 (46) 182 (44) 120 (24) 101 (22) 104 (22) 93 (22) 371 (73) 319 (70) 323 (67) 285 (69) Level 2, n (%) 290 (57) 286 (63) 287 (60) 256 (61) 77 (15) 73 (16) 90 (19) 78 (19) 232 (46) 223 (49) 243 (51) 218 (52) 343 (68) 315 (70) 334 (69) 285 (69) 128 (25) 126 (28) 155 (32) (2) 1 (2) 2 (4) 3 (7) 8 (16) 10 (22) 14 (29) 16 (38) 44 (87) 34 (8) 43 (9) 37 (9) 8 (2) 8 (2) 4 (1) 7 ( Number reporting some problems, n (%) 290 (58) 287 (64) 287 (60) 256 (61) 78 (16) 74 (17) 92 (19)<...>…”

Section: Health-related Quality Of Lifementioning

confidence: 99%

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Clinical effectiveness and cost-effectiveness of a multifaceted podiatry intervention for falls prevention in older people: a multicentre cohort randomised controlled trial (the REducing Falls with ORthoses and a Multifaceted podiatry intervention trial)

Cockayne

Rodgers

Green

et al. 2017

Health Technol Assess

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BackgroundFalls are a serious cause of morbidity and cost to individuals and society. Evidence suggests that foot problems and inappropriate footwear may increase the risk of falling. Podiatric interventions could help reduce falls; however, there is limited evidence regarding their clinical effectiveness and cost-effectiveness.ObjectivesTo determine the clinical effectiveness and cost-effectiveness of a multifaceted podiatry intervention for preventing falls in community-dwelling older people at risk of falling, relative to usual care.DesignA pragmatic, multicentred, cohort randomised controlled trial with an economic evaluation and qualitative study.SettingNine NHS trusts in the UK and one site in Ireland.ParticipantsIn total, 1010 participants aged ≥ 65 years were randomised (intervention,n = 493; usual care,n = 517) via a secure, remote service. Blinding was not possible.InterventionsAll participants received a falls prevention leaflet and routine care from their podiatrist and general practitioner. The intervention also consisted of footwear advice, footwear provision if required, foot orthoses and foot- and ankle-strengthening exercises.Main outcome measuresThe primary outcome was the incidence rate of falls per participant in the 12 months following randomisation. The secondary outcomes included the proportion of fallers and multiple fallers, time to first fall, fear of falling, fracture rate, health-related quality of life (HRQoL) and cost-effectiveness.ResultsThe primary analysis consisted of 484 (98.2%) intervention and 507 (98.1%) usual-care participants. There was a non-statistically significant reduction in the incidence rate of falls in the intervention group [adjusted incidence rate ratio 0.88, 95% confidence interval (CI) 0.73 to 1.05;p = 0.16]. The proportion of participants experiencing a fall was lower (50% vs. 55%, adjusted odds ratio 0.78, 95% CI 0.60 to 1.00;p = 0.05). No differences were observed in key secondary outcomes. No serious, unexpected and related adverse events were reported. The intervention costs £252.17 more per participant (95% CI –£69.48 to £589.38) than usual care, was marginally more beneficial in terms of HRQoL measured via the EuroQoL-5 Dimensions [mean quality-adjusted life-year (QALY) difference 0.0129, 95% CI –0.0050 to 0.0314 QALYs] and had a 65% probability of being cost-effective at the National Institute for Health and Care Excellence threshold of £30,000 per QALY gained. The intervention was generally acceptable to podiatrists and trial participants.LimitationsOwing to the difficulty in calculating a sample size for a count outcome, the sample size was based on detecting a difference in the proportion of participants experiencing at least one fall, and not the primary outcome. We are therefore unable to confirm if the trial was sufficiently powered for the primary outcome. The findings are not generalisable to patients who are not receiving podiatry care.ConclusionsThe intervention was safe and potentially effective. Although the primary outcome measure did not reach significance, a lower fall rate was observed in the intervention group. The reduction in the proportion of older adults who experienced a fall was of borderline statistical significance. The economic evaluation suggests that the intervention could be cost-effective.Future workFurther research could examine whether or not the intervention could be delivered in group sessions, by physiotherapists, or in high-risk patients.Trial registrationCurrent Controlled Trials ISRCTN68240461.FundingThis project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full inHealth Technology Assessment; Vol. 21, No. 24. See the NIHR Journals Library website for further project information.

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Knowledge about foot‐specific foot falls risk factors and exercise among physiotherapists in the UK and Portugal: A cross‐sectional survey

Conde

Hendry

Woodburn

et al. 2022

Physiotherapy Res Intl

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Background and purpose: Foot-related falls risk factors and specific foot and ankle exercise interventions are within the scope of Physiotherapy, yet little is known about United Kingdom (UK) and Portugal-based (PT) physiotherapists' selfperceived knowledge, confidence and practice of such interventions, or perceptions of patients' falls prevention knowledge. The purpose of this study was to assess levels of self-reported knowledge, confidence, and practices surrounding foot-specific falls risk and exercise for fall prevention in physiotherapists working in the UK and in Portugal. It also aimed to explore physiotherapists' views about their participants' falls prevention knowledge. Methods: A self-report online survey was developed, and pilot tested in both nations. Registered Physiotherapists were invited to participate through their professional associations, social media and snowballing. Mann-Whitney tests were used to compare mean ranks of ordinal variables between nations and Chi-square test to assess the independency between pairs of variables. Spearman's correlation coefficient (rs) was used to measure the association between pairs of variables (p < 0.05). Results: 682 physiotherapists participated in the survey [UK n = 229 (mean (SD) age = 43(10) years, 86.9% female]; PT n = 453 (mean (SD) age = 33(9) years, 78.3% female]. Among physiotherapists with a caseload of ≥70% older adults, more PT-based physiotherapists held postgraduate qualifications (p = 0.01). Most physiotherapists correctly identified generic and foot-specific risk factors (≥70% of participants for each item). More UK-based physiotherapists reported always prescribing ankle and foot exercises (42.6% vs. 33%, p =< 0.001) and displayed higher levels of self-reported confidence surrounding exercise-based interventions. Discussion: Our sample of UK and Portugal-based physiotherapists are aware of the contribution of foot-specific risk factors and exercise to falls prevention, with the former group being more confident in exercise-based interventions. Both groups of physiotherapists perceived that their older patients had little knowledge aboutThis is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.

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Effectiveness of Foot and Ankle Exercise Programs on Reducing the Risk of Falling in Older Adults

Cited by 33 publications

References 54 publications

Prediction of Dynamic Postural Stability During Single-Leg Jump Landings by Ankle and Knee Flexibility and Strength

Prediction of Dynamic Postural Stability During Single-Leg Jump Landings by Ankle and Knee Flexibility and Strength

Clinical effectiveness and cost-effectiveness of a multifaceted podiatry intervention for falls prevention in older people: a multicentre cohort randomised controlled trial (the REducing Falls with ORthoses and a Multifaceted podiatry intervention trial)

Knowledge about foot‐specific foot falls risk factors and exercise among physiotherapists in the UK and Portugal: A cross‐sectional survey

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