TY  - JOUR
PY  - 2017//
TI  - Cohort randomised controlled trial of a multifaceted podiatry intervention for the prevention of falls in older people (the REFORM Trial)
JO  - PLoS one
A1  - Cockayne, Sarah
A1  - Adamson, Joy
A1  - Clarke, Arabella
A1  - Corbacho, Belen
A1  - Fairhurst, Caroline
A1  - Green, Lorraine
A1  - Hewitt, Catherine E.
A1  - Hicks, Kate
A1  - Kenan, Anne-Maree
A1  - Lamb, Sarah E.
A1  - McIntosh, Caroline
A1  - Menz, Hylton B.
A1  - Redmond, Anthony C.
A1  - Richardson, Zoe
A1  - Rodgers, Sara
A1  - Vernon, Wesley
A1  - Watson, Judith
A1  - Torgerson, David J.
SP  - e0168712
EP  - e0168712
VL  - 12
IS  - 1
N2  - BACKGROUND: Falls are a major cause of morbidity among older people. A multifaceted podiatry intervention may reduce the risk of falling. This study evaluated such an intervention. <br><br>DESIGN: Pragmatic cohort randomised controlled trial in England and Ireland. 1010 participants were randomised (493 to the Intervention group and 517 to Usual Care) to either: a podiatry intervention, including foot and ankle exercises, foot orthoses and, if required, new footwear, and a falls prevention leaflet or usual podiatry treatment plus a falls prevention leaflet. The primary outcome was the incidence rate of self-reported falls per participant in the 12 months following randomisation. Secondary outcomes included: proportion of fallers and those reporting multiple falls, time to first fall, fear of falling, Frenchay Activities Index, Geriatric Depression Scale, foot pain, health related quality of life, and cost-effectiveness. <br><br>RESULTS: In the primary analysis were 484 (98.2%) intervention and 507 (98.1%) control participants. There was a small, non statistically significant reduction in the incidence rate of falls in the intervention group (adjusted incidence rate ratio 0.88, 95% CI 0.73 to 1.05, p = 0.16). The proportion of participants experiencing a fall was lower (49.7 vs 54.9%, adjusted odds ratio 0.78, 95% CI 0.60 to 1.00, p = 0.05) as was the proportion experiencing two or more falls (27.6% vs 34.6%, adjusted odds ratio 0.69, 95% CI 0.52 to 0.90, p = 0.01). There was an increase (p = 0.02) in foot pain for the intervention group. There were no statistically significant differences in other outcomes. The intervention was more costly but marginally more beneficial in terms of health-related quality of life (mean quality adjusted life year (QALY) difference 0.0129, 95% CI -0.0050 to 0.0314) and had a 65% probability of being cost-effective at a threshold of £30,000 per QALY gained. <br><br>CONCLUSION: There was a small reduction in falls. The intervention may be cost-effective. TRIAL REGISTRATION: ISRCTN ISRCTN68240461.<p />  <p>Language: en</p>
LA  - en
SN  - 1932-6203
UR  - http://dx.doi.org/10.1371/journal.pone.0168712
ID  - ref1
ER  -