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Lincoln, Yvonna, and Egon Guba, "Postpositivism and the Naturalist Paradigm," pp. 14-46 in Yvonna Lincoln and Egon Guba, Naturalistic Inquiry . Beverly Hills, CA: Sage, 1985.*

25. Multiple Imputation for Nonresponse in Surveys. By D. B. Rubin. ISBN 0 471 08705 X. Wiley, Chichester, 1987. 258 pp. £30.25.

Multiple Imputation for Nonresponse in Surveys

As people get older, they may fall more often for a variety of reasons including problems with balance, poor vision, and dementia. Up to 30% may fall in a year. Although one in five falls may require medical attention, less than one in 10 results in a fracture.
This review looked at the healthcare literature to establish which fall prevention interventions are effective for older people living in the community, and included 159 randomised controlled trials with 79,193 participants.  
Group and home-based exercise programmes, usually containing some balance and strength training exercises, effectively reduced falls, as did Tai Chi. Overall, exercise programmes aimed at reducing falls appear to reduce fractures.
Multifactorial interventions assess an individual's risk of falling, and then carry out treatment or arrange referrals to reduce the identified risks. Overall, current evidence shows that this type of intervention reduces the number of falls in older people living in the community but not the number of people falling during follow-up. These are complex interventions, and their effectiveness may be dependent on factors yet to be determined.  
Interventions to improve home safety appear to be effective, especially in people at higher risk of falling and when carried out by occupational therapists. An anti-slip shoe device worn in icy conditions can also reduce falls.
Taking vitamin D supplements does not appear to reduce falls in most community-dwelling older people, but may do so in those who have lower vitamin D levels in the blood before treatment.  
Some medications increase the risk of falling. Three trials in this review failed to reduce the number of falls by reviewing and adjusting medications. A fourth trial involving family physicians and their patients in medication review was effective in reducing falls. Gradual withdrawal of a particular type of drug for improving sleep, reducing anxiety, and treating depression (psychotropic medication) has been shown to reduce falls.
Cataract surgery reduces falls in women having the operation on the first affected eye. Insertion of a pacemaker can reduce falls in people with frequent falls associated with carotid sinus hypersensitivity, a condition which causes sudden changes in heart rate and blood pressure.
In people with disabling foot pain, the addition of footwear assessment, customised insoles, and foot and ankle exercises to regular podiatry reduced the number of falls but not the number of people falling.
The evidence relating to the provision of educational materials alone for preventing falls is inconclusive.

Interventions for preventing falls in older people living in the community

The Pharmacological Basis of Therapeutics A Textbook of Pharmacology, Toxicology and Therapeutics for Physicians and Medical Students. By Prof. Louis Goodman and Prof. Alfred Gilman. Pp. xiii + 1383. (New York: The Macmillan Company, 1941.) 50s. net.

The Pharmacological Basis of Therapeutics

Test–retest reliability of spatial and temporal gait parameters of people with Alzheimer's disease

The aim of this study was to evaluate the relative contribution of structural foot characteristics and comorbidities to the presence of disabling foot pain in older people. One hundred seventy-two people (55 men and 117 women) aged 62 to 96 years (mean +/- SD, 80.1 +/- 6.4 years) who lived in a retirement village underwent tests of foot posture, range of motion, and deformity in addition to completing a medical history questionnaire. Disabling foot pain was determined using the Manchester Foot Pain and Disability Index. Thirty-eight subjects (22%) reported disabling foot pain. Subjects with disabling foot pain had a higher body mass index and were more likely to be female; to report osteoarthritis in the spine, hips, hands or wrists, and feet; and to report pain in the back, hips, and hands or wrists. The only significant difference between the groups regarding structural foot characteristics was that those with disabling foot pain exhibited more severe hallux valgus deformity. The strongest determinants of disabling foot pain revealed by a discriminant function analysis were foot osteoarthritis, pain in the hips, and pain in the hands or wrists. These findings indicate that disabling foot pain in older people is more closely related to pain and osteoarthritis in other body regions than to structural characteristics of the foot, and they suggest that more severe forms of foot pain in older people may be a component of a general chronic pain syndrome or a polyarticular form of osteoarthritis.

Determinants of disabling foot pain in retirement village residents.

Objective

To determine whether there are differences in the foot-specific and general health-related quality of life (HRQOL) of people with and without first metatarsophalangeal (MTP) joint osteoarthritis (OA).



Methods

The foot-specific and general HRQOL of 43 participants (mean ± SD age 50.0 ± 10.8 years) with symptomatic radiographically confirmed first MTP joint OA (case group) was compared to an age-, sex-, and body mass index–matched control group. Foot-specific HRQOL was assessed using the Foot Health Status Questionnaire (FHSQ) and general HRQOL was assessed using the Short Form 36 (SF-36) questionnaire. Both questionnaires are validated instruments with 0–100-point domains.



Results

All domains of the FHSQ were significantly lower in the case group (mean ± SD foot pain 55.5 ± 22.3 versus 93.0 ± 7.8, foot function 73.8 ± 20.9 versus 96.9 ± 11.5, footwear 39.1 ± 28.7 versus 76.6 ± 27.0, and general foot health 50.2 ± 27.0 versus 89.7 ± 16.0). Further, the SF-36 physical functioning domain was significantly lower (mean ± SD 82.8 ± 14.7 versus 95.2 ± 6.3) in the case group.



Conclusion

People with first MTP joint OA experience more foot pain, have greater difficulty performing functional weight-bearing activities, find it more difficult to obtain suitable footwear, and perceive their feet to be in a poorer state of health. Additionally, people with symptomatic first MTP joint OA have greater difficulty performing a broad range of physical tasks and activities.

https://onlinelibrary.wiley.com/doi/pdf/10.1002/acr.21729

Impact of first metatarsophalangeal joint osteoarthritis on health-related quality of life.

Background: Foot posture is considered to be an important component of musculoskeletal assessment in clinical practice and research. However, many measurement approaches are not suitable for routine use as they are time-consuming or require specialised equipment and/or clinical expertise. The objective of this study was therefore to develop and evaluate a simple visual tool for foot posture assessment based on the Arch Index (AI) that could be used in clinical and research settings. Methods: Fully weightbearing footprints from 602 people aged 62 to 96 years were obtained using a carbon paper imprint material, and cut-off AI scores dividing participants into three categories (high, normal and low) were determined using the central limit theorem (i.e. normal=+/� 1 standard deviation from the mean). A visual tool was then created using representative examples for the boundaries of each category. Two examiners were then asked to use the tool to independently grade the footprints of 60 participants (20 for each of the three categories, randomly presented), and then repeat the process two weeks later. Inter- and intra-tester reliability was determined using Spearman’s rho, percentage agreement and weighted kappa statistics. The validity of the examiner’s assessments was evaluated by comparing their categorisations to the actual AI score using Spearman’s rho and analysis of variance (ANOVA), and to the actual AI category using percentage agreement, Spearman’s rho and weighted kappa. Results: Inter- and intra-tester reliability of the examiners was almost perfect (percentage agreement=93 to 97%; Spearman’s rho=0.91 to 0.95, and weighted kappas=0.85 to 0.93). Examiner’s scores were strongly correlated with actual AI values (Spearman’s rho=0.91 to 0.94 and significant differences between all categories with ANOVA; p<0.001) and AI categories (percentage agreement=95 to 98%; Spearman’s rho=0.89 to 0.94, and weighted kappas=0.87 to 0.94). There was a slight tendency for examiners to categorise participants as having higher arches than their AI scores indicated. Conclusions: Foot posture can be quickly and reliably categorised as high, normal or low in older people using a simplified visual categorisation tool based on the AI.

/pdf/visual-categorisation-of-the-arch-index-a-simplified-measure-2uiljz0aya.pdf

Visual categorisation of the arch index: a simplified measure of foot posture in older people.

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Hylton B. Menz

Papers

Test–retest reliability of spatial and temporal gait parameters of people with Alzheimer's disease

Determinants of disabling foot pain in retirement village residents.

Impact of first metatarsophalangeal joint osteoarthritis on health-related quality of life.

Visual categorisation of the arch index: a simplified measure of foot posture in older people.

Comprar Falls in Older People. Risk Factors and Strategies for Prevention. | Stephen R. Lord | 9780521680998 | Cambridge University Press