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Cohort randomised controlled trial of a multifaceted podiatry intervention for the prevention of falls in older people (The REFORM Trial)

The REFORM study evaluated a newly developed podiatry intervention to see if it was more effective at preventing falls than regular podiatry treatment. The study found there was no significant difference in the number of falls between the intervention group and the regular treatment group. 

Why did we do this research?

Falls are a major cause of morbidity among older people, and it is thought the risk of falling is increased due to foot problems and inappropriate footwear. Therefore, a podiatry intervention could reduce the risk of falling and increase health outcomes in this population. 

What did we do?

Participants were randomised to either a podiatry intervention group or control group. Those in the intervention group received foot and ankle strengthening exercises, foot orthoses, new footwear if required, and a falls prevention leaflet. Those in the control group received usual podiatry treatment plus a falls prevention leaflet. Participants self-reported falls over the next 12 months.  

Who was involved?

Nine NHS trusts in the UK and one in Ireland were involved in recruiting 1010 participants aged 65 and over. 

What did we find?

There was a lower incidence of falls in the intervention group, however the difference in falls between the intervention and control group were not significant. This suggests the intervention may be no more effective at preventing falls than regular podiatry treatment. A health economics evaluation did suggest the intervention could be cost effective. 

What happens next?

Future studies could look at whether the intervention could be delivered in a group setting, by physiotherapists, or in high risk groups. 


Cockayne S, Rodgers S, Green L, Fairhurst C, Adamson J, Scantlebury A, et al. Clinical effectiveness and cost-effectiveness of a multifaceted podiatry intervention for falls prevention in older people: a multicentre cohort randomised controlled trial (the REducing Falls with ORthoses and a Multifaceted podiatry intervention trial). Health Technol Assess 2017;21(24) doi:

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David Torgerson
Sarah Cockayne
Sara Rodgers
Caroline Fairhurst
Joy Adamson
Arabella Scantlebury
Belen Corbacho
Catherine Hewitt
Kate Hicks
Zoe Richardson
Jude Watson
Department of Health Sciences, University of York, York, UK

Lorraine Green
Anne-Maree Keenan
Anthony Redmond
Leeds Institute of Rheumatic and Musculoskeletal Medicine, Faculty of Medicine and Health, University of Leeds, Leeds, UK
National Institute for Health Research (NIHR) Leeds Musculoskeletal Biomedical Research Unit, Leeds, Teaching Hospitals NHS Trust, Leeds, UK

Robin Hull
Podiatry Department, Harrogate and district NHS Foundation Trust, Harrogate, UK

Sarah E Lamb
Oxford NIHR Biomedical Research Unit, Oxford, UK

Caroline McIntosh
Discipline of Podiatric Medicine, National University of Ireland Galway, Galway, Ireland 

Hylton B Menz
School of Allied Health, College of Science, Health and Engineering, La Trobe University, Melbourne, VIC, Australia

Wesley Wernon
Podiatry Department, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK


The research was commissioned by NIHR HTA programme (Award ID: 09/77/01) and a grant of £1,212,678.91 awarded. The project was started in December 2011 and completed in April 2016.

Study registration

The study was registered on the ISRCTN register:


Multifaceted podiatry intervention for fall prevention in patients over 65 years of age