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Using Multivariate Statistics

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

Introduction
Corticosteroid injections and foot orthoses are common interventions for plantar heel pain. Previous clinical trials have found that the effectiveness of these interventions differs over time, with corticosteroid injections being more effective in the short-term (i.e. 0–4 weeks) and foot orthoses more effective in the longer-term (i.e. 5–12 weeks). However, some of these trials have methodological weaknesses that could have caused confounding and bias, which may have led to over- or under-estimation of the effectiveness of these interventions. As a result, there is a need to compare the effectiveness of corticosteroid injections and foot orthoses in a robust clinical trial with an appropriate follow-up time.

Corticosteroid injections compared to foot orthoses for plantar heel pain: protocol for the SOOTHE heel pain randomised trial

Ageing and Falls

/pdf/188-the-epidemiology-of-midfoot-pain-and-symptomatic-midfoot-3vn9fen5i0.pdf

188. The Epidemiology of Midfoot Pain and Symptomatic Midfoot Osteoarthritis: Cross-Sectional Findings from the Clinical Assessment Study of the Foot

Recent events in the USA and UK have raised questions about the appropriate definition and application of the terms 'foot' and 'surgeon'. In this editorial, we explore these issues and clarify our use of these terms in the journal.

/pdf/foot-and-surgeon-a-tale-of-two-definitions-1t57atid66.pdf

'Foot' and 'surgeon': a tale of two definitions

Background: Falls in older people are a major public health problem, and there is increasing evidence that foot problems and inappropriate footwear increase the risk of falls. Several multidisciplinary prevention clinics have been established to address the problem of falls; however, the role of podiatry in these clinics has not been clearly defined. The aims of this study were to determine the level of podiatric involvement in multidisciplinary falls clinics in Australia and to describe the assessments undertaken and interventions provided by podiatrists in these settings. Methods: A database of falls clinics was developed through consultation with departments of health in each state and territory. Clinic managers were contacted and surveyed as to whether the clinic incorporated podiatry services. If so, the podiatrists were contacted and asked to complete a brief questionnaire regarding their level of involvement and the assessment procedures and interventions offered. Results: Of the 36 clinics contact...

Hylton B. Menz

Papers

Corticosteroid injections compared to foot orthoses for plantar heel pain: protocol for the SOOTHE heel pain randomised trial

Ageing and Falls

188. The Epidemiology of Midfoot Pain and Symptomatic Midfoot Osteoarthritis: Cross-Sectional Findings from the Clinical Assessment Study of the Foot

'Foot' and 'surgeon': a tale of two definitions

Podiatric involvement in multidisciplinary falls-prevention clinics in Australia