SLR - September 2017 - Sharon M. Overall
Podiatry Intervention vs. Usual Care to Prevent Falls in Care Homes: Pilot Randomized Controlled Trial (the PIRFECT Study)
Reference: Wylie G, Menz HB, McFarlane S, Ogston S, Sullivan F, Williams B, Young Z, Morris J. Podiatry Intervention Versus Usual Care to Prevent Falls in Care Homes: Pilot Randomized Controlled Trial (the PIRFECT study.) BMC Geriatr. 2017 Jul 12; 17(1): 143.
Scientific Literature Review
Reviewed By: Sharon M. Overall, DPM
Residency Program: Beaumont Hospital, Farmington Hills, MI
Podiatric Relevance: Half of all long-term care facility residents fall at least once every year. Multiple comorbidities and medications can impair balance in this already frail population leading to falls, hospitalization and death. Pedal pathology adds additional risk for falls, namely a decrease in ankle joint range of motion, hallux valgus deformity, decreased strength in toe plantar-flexion, an increase in heel height of the shoe, lack of proper lacing or strapping of the shoes and a decrease in the surface area of sole to shoe contact.
Methods: A two-arm parallel group pilot randomized controlled single blind trial was performed involving residents of six care homes between January 2014 and June 2014. The criteria for inclusion in the study included being age 65+, permanent placement in a care home, one or more falls in the past year, a pedal risk factor as outlined above and the ability to provide informed consent. Primary outcomes assessed were number of falls and the time to the first fall in both groups. Secondary outcomes considered include balance, functional ability, strength, quality of life, activities of daily living, falls self-efficacy and pedal pathology.
Results: Of 474 potential participants, 47 met the inclusion criteria. Four patients dropped out of the study prior to randomization leaving 43 patients to be randomly assigned to either the intervention group (23 patients) or the control group (20 patients). Both groups received core podiatric care, including nail and callus debridement. In addition, the intervention group either had or were provided with full length prefabricated orthotics and approved shoes along with foot and ankle exercise instructions.
Ninety-seven falls were recorded from baseline to the end of the six-month follow-up period; 49 in the intervention group (48 percent of participants) and 48 in the control group (71 percent of participants). Multiple falls occurred in 33 percent of the intervention group and 53 percent in the control group. Those in the intervention group had an average first fall time of 91 days (42 days to 257 days). The control group had an average first fall time of 64 days (two days to 160 days).
Conclusion: This pilot study was performed to determine the feasibility and efficacy of a future full-scale multicenter study involving podiatric intervention and fall prevention in care home patients. Based on the small size of this study, the effectiveness of the intervention cannot be extrapolated for a larger population. However, it is reasonable to consider a future full-scale trial as podiatric preventative medicine, including core podiatric care, proper footgear and orthotics, and foot and ankle exercises, may be beneficial in reducing the risk of falls.