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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

Background It has been suggested that plantar forefoot pain (‘metatarsalgia’) may be caused by the presence of abnormally long lesser metatarsals leading to excessive loading of the metatarsal heads when walking. However, evidence to support this proposed mechanism is limited. Therefore, the objective of this study was to determine whether plantar pressures during gait and the relative lengths of the lesser metatarsals differ between older people with and without plantar forefoot pain. Materials and methods Dynamic plantar pressure assessment during walking was undertaken using the Tekscan MatScan system in 118 community-dwelling older people (44 males and 74 females, mean age 74.0 years, standard deviation [SD] 5.9), 43 (36%) of whom reported current or previous plantar forefoot pain. Seven individual “masks” were constructed to determine peak pressures under the hallux, the lesser toes, metatarsal head 1, metatarsal head 2, metatarsal heads 3 to 5, the midfoot and the heel (see Figure 1). The relative lengths of metatarsals 1 to 5 were

/pdf/plantar-pressures-and-relative-metatarsal-lengths-in-older-2wbllzeelq.pdf

Plantar pressures and relative metatarsal lengths in older people with and without forefoot pain

Background Plantar heel pain is one of the most common musculoskeletal conditions affecting the foot and it is commonly experienced by older adults. Contoured foot orthoses and some heel inserts have been found to be effective for plantar heel pain, however the mechanism by which they achieve their effects is largely unknown. The aim of this study was to investigate the effects of foot orthoses and heel inserts on plantar pressures in older adults with plantar heel pain.

/pdf/the-effect-of-heel-inserts-and-foot-orthoses-in-older-people-49g40cz9pj.pdf

Hylton B. Menz

Papers

Plantar pressures and relative metatarsal lengths in older people with and without forefoot pain

The effect of heel inserts and foot orthoses in older people with plantar heel pain.

Chapter 5 – Other skin disorders

Chapter 12 – Footwear considerations

Contemporary methods in patellofemoral joint radiography and grading of patellofemoral osteoarthritis: a systematic review