title: Predictors of adherence to a multifaceted podiatry intervention for the prevention of falls in older people.
abstract: BACKGROUND
  Despite emerging evidence that foot problems and inappropriate footwear increase the risk of falls, there is little evidence as to whether foot-related intervention strategies can be successfully implemented. The aim of this study was to evaluate adherence rates, barriers to adherence, and the predictors of adherence to a multifaceted podiatry intervention for the prevention of falls in older people.
  
  
  METHODS
  The intervention group (n = 153, mean age 74.2 years) of a randomised trial that investigated the effectiveness of a multifaceted podiatry intervention to prevent falls was assessed for adherence to the three components of the intervention: (i) foot orthoses, (ii) footwear advice and footwear cost subsidy, and (iii) a home-based foot and ankle exercise program. Adherence to each component and the barriers to adherence were documented, and separate discriminant function analyses were undertaken to identify factors that were significantly and independently associated with adherence to the three intervention components.
  
  
  RESULTS
  Adherence to the three components of the intervention was as follows: foot orthoses (69%), footwear (54%) and home-based exercise (72%). Discriminant function analyses identified that being younger was the best predictor of orthoses use, higher physical health status and lower fear of falling were independent predictors of footwear adherence, and higher physical health status was the best predictor of exercise adherence. The predictive accuracy of these models was only modest, with 62 to 71% of participants correctly classified.
  
  
  CONCLUSIONS
  Adherence to a multifaceted podiatry intervention in this trial ranged from 54 to 72%. People with better physical health, less fear of falling and a younger age exhibited greater adherence, suggesting that strategies need to be developed to enhance adherence in frailer older people who are most at risk of falling.
  
  
  BACKGROUND
  Australian New Zealand Clinical Trials Registry ACTRN12608000065392.
authors.affiliation: Musculoskeletal Research Centre, Faculty of Health Sciences, La Trobe University, Bundoora Victoria, Australia.
authors.forename: Martin J
authors.initials: MJ
authors.lastname: Spink
authors.forename: Mohammad R
authors.initials: MR
authors.lastname: Fotoohabadi
authors.forename: Elin
authors.initials: E
authors.lastname: Wee
authors.forename: Karl B
authors.initials: KB
authors.lastname: Landorf
authors.forename: Keith D
authors.initials: KD
authors.lastname: Hill
authors.forename: Stephen R
authors.initials: SR
authors.lastname: Lord
authors.forename: Hylton B
authors.initials: HB
authors.lastname: Menz
mesh_terms: D000058:Accidental Falls / Q000517:prevention & control*; D000368:Aged; D000369:Aged, 80 and over; D005081:Exercise Therapy / Q000191:economics / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D009989:Orthotic Devices / Q000191:economics; D010349:Patient Compliance / Q000523:psychology*; D011032:Podiatry; D011237:Predictive Value of Tests; D012307:Risk Factors