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Wylie G, Torrens C, Campbell P, et al. Podiatry interventions to prevent falls in older people: a systematic review and meta-analysis. Age Ageing. 2019 Jan 7. pii: 5274645. doi: 10.1093/ageing/afy189. (Systematic review)
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.

PROSPERO registration number: CRD42017068300.

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Physician 6 / 7
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Comments from MORE raters

Physician rater

This is an interesting systematic review. A number of guidelines on the prevention of falls mention the assessment and treatment of foot problems in older community-dwelling patients. It appears that either a multifaceted podiatry intervention or including it as part of a multifactorial intervention offered to the older at-risk patient might be necessary for it to be effective.

Physician rater

The leading cause of injuries in the trauma service of our academically-affiliated level 1 trauma center is NOT motor vehicle accidents or assault-related injuries. It IS injuries sustained after fall in older adults. Simple interventions to minimize falls and fall-related injury in older adults is imperative in our society with increasing aging populations. May practitioners in primary care probably don't know the potential effectiveness of podiatry intervention.

Physician rater

Podiatric interventions should be encouraged in the elder population for reducing falls. This Cochrane meta-analysis show significant effects for multifaceted (callus debridement, exercise, footwear, orthoses) and multifactorial (provided by a multidisciplinary team) podiatry interventions reducing falls rate in the Elder population. However, the confidence intervals are close to 1 (no effect) and there were no significant effects with single component podiatry intervention.

Physician rater

This systematic review is interesting but suffers from the limitations of the studies it includes. It found podiatry interventions reduce falls if included as part of a multi-component intervention or 'multi-faceted' podiatry intervention. It does not work as a single-faceted intervention. This begs the question whether podiatry really works at all because the common theme in studies that were more effective is that the podiatry interventions included foot and ankle exercises. It is already well established that exercise reduces falls risk so I remain dubious that podiatry 'per se' is definitely helpful. It is also unclear who would benefit most, if anyone.
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