Moderate-quality evidence shows podiatric interventions can prevent falls but not injuries in community-dwelling elderly

Reference

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;48(3):327-336.

Synopsis

These authors searched multiple databases, registries, and the grey literature to find randomized and quasi-randomized trials of podiatry interventions for the prevention of falls in the elderly living at home or in care homes. The interventions had to address foot pain, improve balance, or improve foot health, and they could be delivered by podiatrists or trained staff. Two authors independently assessed the inclusion of studies and their methodologic quality, and they resolved disagreements by discussion and third-party adjudication. Of the 9 finalists, 6 of the studies were randomized trials, 2 were quasi-experimental, and 1 was a cluster randomized trial. Only 2 studies took place in care homes, the rest took place in the community. Six of the studies required the participants to have had previous falls or to be at high risk of falls. The studies ranged in size from 40 to 3727 participants (total = 6502). Most lasted 3 to 4 months, but 3 studies lasted for more than a year. Overall, the studies were of modest quality. Among the possible hiccups, selective reporting and a lack of masking were the 2 most common. Single component interventions did not reduce the rate of falls (falls actually increased, but the data are from only 2 small studies). However, multifaceted interventions (such as foot care, exercises, footwear, and orthotics) and multifactorial interventions (based on risk assessment and referral to a podiatrist) were each associated with modest reductions in the rate of falls (falls rate ratio 0.77 [95% CI 0.61 - 0.99] and 0.73 [0.54 - 0.98], respectively). Six studies reported injuries, and the overall rate ratios ranged from 0.87 to 1.11. Finally, the 2 studies of patients in care homes did not provide data for pooling.