Podiatry intervention versus usual care to prevent falls in care homes: pilot randomised controlled trial (the PIRFECT study)

Abstract

BackgroundCommon foot problems are independent risk factors for falls in older people. There is evidence that podiatry can prevent falls in community-dwelling populations. The feasibility of implementing a podiatry intervention and trial in the care home population is unknown. To inform a potential future definitive trial, we performed a pilot randomised controlled trial to assess: (i) the feasibility of a trial of a podiatry intervention to reduce care home falls, and (ii) the potential direction and magnitude of the effect of the intervention in terms of number of falls in care home residents.MethodsInformed by Medical Research Council guidance on developing and evaluating complex interventions, we conducted a single blind, pilot randomised controlled trial in six care homes in the East of Scotland. Participants were randomised to either: (i) a three month podiatry intervention comprising core podiatry care, foot and ankle exercises, orthoses and footwear provision or (ii) usual care. Falls-related outcomes (number of falls, time to first fall) and feasibility-related outcomes (recruitment, retention, adherence, data collection rates) were collected. Secondary outcomes included: generic health status, balance, mobility, falls efficacy, and ankle joint strength.Results474 care home residents were screened. 43 (9.1%) participants were recruited: 23 to the intervention, 20 to control. Nine (21%) participants were lost to follow-up due to declining health or death. It was feasible to deliver the trial elements in the care home setting. 35% of participants completed the exercise programme. 48% reported using the orthoses ‘all or most of the time’. Completion rates of the outcome measures were between 93% and 100%. No adverse events were reported. At the nine month follow-up period, the intervention group per-person fall rate was 0.77 falls vs. 0.83 falls in the control group.ConclusionsA podiatry intervention to reduce falls can be delivered to care home residents within a pilot randomised controlled trial of the intervention. Although not powered to determine effectiveness, these preliminary data provide justification for a larger trial, incorporating a full process evaluation, to determine whether this intervention can significantly reduce falls in this high-risk population.Trial registrationClinicalTrials.gov identifier: NCT02178527; Date of registration: 17 June 2014.Electronic supplementary materialThe online version of this article (doi:10.1186/s12877-017-0541-1) contains supplementary material, which is available to authorized users.

Systematic scoping review of frameworks used to develop rehabilitation interventions for older adults

“…The most common population descriptor was community dwelling or older adults of a certain age 17 19 27 29 31 44 45. Underlying conditions included mild cognitive impairment and dementia (n=5),18 28 30 32 34 cardiac conditions (n=4),15 24–26 stroke (n=3),22 38 40 falls and fear of falling (n=3),21 35 48 hip fracture (n=2),37 39 diabetes (n=2),14 41 42 breast cancer,20 Parkinson’s disease,16 depression,23 chronic health problems,33 osteoarthritis,36 leg ulcer,43 neck pain46 and foot problems 47…”

“…The types of interventions reported were varied and included multicomponent (n=12),14 19 23 24 26–29 36 39 42 45 support based (n=5),15 16 18 30 41 cognitive interventions (n=5),31 33 34 40 48 physical activities (n=3),17 32 46 nursing (n=2),25 43 falls prevention,21 occupational therapy,22 poststroke care,38 podiatry47 and dietary advice 37…”

Evaluation of the development process and effects of a foot care program with educational tools for nurses and care workers as in-home service providers

“…In contrast to podiatrists in other countries [48], there is no guarantee that referred patients will see a doctor who has adequate foot care knowledge. Such patients may feel disappointed or may be referred to a different doctor.…”

The Footfall Programme: participant experiences of a lower limb, foot and ankle exercise intervention for falls prevention - an exploratory study

“…Despite growing evidence that foot and ankle exercises appear to be effective for falls prevention when integrated in multifaceted podiatry interventions [10][11][12] , their effectiveness as standalone interventions within a home-based or blended context remains unclear. These studies did not offer insight into older adults' views and preferences of the exercise programme characteristics that could potentially promote their long-term maintenance.…”

“…The Footfall programme is a standalone lower limb, foot and ankle exercise programme that has adapted the delivery and exercises (including the equipment used), from the original study by Spink et al 11 , for use in the UK and in Portugal. There is a scarcity of published qualitative evidence focusing on Portuguese Older Adults views and attitudes about exercise intervention components and it is not known if the outcome measures are feasible or if the adapted programme is acceptable to older adults in the UK and in Portugal.…”