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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

Abstract Background Maldistribution of podiatrists limits capacity to address the footcare needs of the population. Understanding factors that impact recruitment and retention of Australian podiatrists is a key solution. The primary aim of this study was to describe factors related to rural podiatry work, and overall professional retention amongst Australian podiatrists. Methods We used data collected from the most recent relevant response of a cohort of Australian podiatrists between 2017 and 2020 of four online surveys. Person and job role variables known to impact current work and retention were collected. Logistic regression models were used to determine factors associated with rural work and intent to leave direct patient care or the profession entirely. Results There were 1129 podiatrists (21% of 5429) who participated in at least one of the survey waves. Podiatrists who had a rural background (30%) were less likely to work in a metropolitan location (OR = 0.20, 95%CI = 0.11,0.37). Podiatrists who undertook a regional/rural placement during their undergraduate education (43%) were more likely to work in a metropolitan location (OR = 1.86, 95%CI = 1.38,2.51). Podiatrists who indicated they were planning to leave direct patient care within 5 years ( n = 282, 26%), were less satisfied with working conditions (OR = 0.77, 95% CI = 0.66, 0.92), less satisfied with opportunities to use their abilities (OR = 0.83, 95% CI = 0.69, 0.99), perceived less personal accomplishment (OR = 0.94, 95% CI 0.86, 0.94) and less job satisfaction (OR = 0.92, 95% CI = 0.91, 0.98). Podiatrists who indicated that they were planning to leave podiatry work entirely within 5 years ( n = 223, 21%), were less satisfied with opportunities to use their abilities (OR = 0.74, 95% CI = 0.62, 0.88), agreed they had a poor support network from other podiatrists (OR = 1.35, 95% CI = 1.13, 1.61), had less job satisfaction (OR = 0.89, 95% CI = 0.86, 0.94), and did not have access to paid annual leave (OR = 0.62, 95% CI = 0.38, 0.99). Conclusion Findings suggest ways to promote rural work, including selecting university students with rural backgrounds, and optimising the experience of rural placements which currently predict metropolitan practice. To retain podiatrists, it is important to ensure access to leave, professional support, and appropriate physical working conditions. Further research is required to understand why intention to leave is so high. 

/pdf/describing-the-factors-related-to-rural-podiatry-work-and-2cnnxx0t.pdf

Describing the factors related to rural podiatry work and retention in the podiatry workforce: a national survey

The Immediate Effects Of Foot Orthoses On Functional Performance In Individuals With Patellofemoral Pain Syndrome: 1071

Effectiveness of extracorporeal shockwave treatment in 353 patients with chronic plantar fasciitis (letter to the editor).

Falls in Older People: Medications as risk factors for falls

Background Osteoarthritis (OA) affecting of the first metatarsophalangeal joint (MTPJ), is a common and painful condition. Although several different treatments have been suggested throughout the literature, few have been adequately evaluated. Therefore, the aim of this study was to conduct a Cochrane review in order to determine the efficacy of treatments available for first MTPJ OA. Methods Randomised controlled trials, quasi-randomised trials, or controlled clinical trials that assessed treatment outcomes for first MTPJ OA were searched for across several electronic databases (to the 14th January 2010) (CENTRAL; MEDLINE; EMBASE; CINAHL; and PEDro). Participants of any age or gender with OA of the first MTPJ defined either radiographically or clinically were included in this review. Results Only one trial satisfactorily fulfilled the inclusion criteria and was included in this review. This trial evaluated the effectiveness of two physical therapy programs in 20 individuals with OA of the first MTPJ. Assessment outcomes included pain levels, first MTPJ range of motion and plantarflexion strength of the hallux. Mean differences at 4 weeks follow up were 3.80 points [95% CI: 2.74 to 4.86] for self reported pain, 28.30 degrees [95% CI: 21.37 to 35.23] for first MTPJ range of motion and 2.80 kilograms [95% CI; 2.13 to 3.47] for muscle strength. Although differences in outcomes between treatment and control groups were reported, the risk of bias was high. The trial failed to employ appropriate randomisation or adequate allocation concealment, used a relatively small sample and incorporated a short follow up (4 weeks). No adverse reactions were reported. Conclusions Only one quasi-randomised controlled trial for first MTPJ OA was found. The reviewed trial presented a high risk of bias, limiting the conclusions that could be drawn from the presented data. The inclusion of only one trial indicates the need for more robust randomised controlled trials to determine the efficacy of interventions for this condition.

/pdf/what-is-the-best-available-evidence-for-treatment-of-first-e3pokrndee.pdf

Hylton B. Menz

Papers

Describing the factors related to rural podiatry work and retention in the podiatry workforce: a national survey

The Immediate Effects Of Foot Orthoses On Functional Performance In Individuals With Patellofemoral Pain Syndrome: 1071

Effectiveness of extracorporeal shockwave treatment in 353 patients with chronic plantar fasciitis (letter to the editor).

Falls in Older People: Medications as risk factors for falls

What is the best available evidence for treatment of first metatarsophalangeal joint osteoarthritis