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Ashburn A.1, Robison J.1, Donovan-Hall M.1, Cole M.1, Bowen C.1, Burnett M.1, Mamode L.1, Pickering R.2, Bader D.1, Kunkel D.1
1University of Southampton, Faculty of Health Science, Southampton, United Kingdom, 2University of Southampton, Faculty of Medicine, Southampton, United Kingdom
Background: First time stroke occurs almost 17 million times a year worldwide and the impact of stroke on an individual is greater than for other chronic conditions. Gait and instability are common and frequent falls may lead to injuries, loss of confidence and independence. In a 12-month period 50-75% of people with stroke (PwS) living in the community will have fallen at least once in comparison to one third of the general population over 65 years. Among the older population there is evidence that foot problems affect balance and whilst shoes can protect foot health and facilitate propulsion certain footwear characteristics may be associated with increased risk of falls and fractures. The nature of foot problems experienced, footwear choice, and factors impacting that choice in PwS have not been thoroughly explored. In fact there appears to be a lack of detailed understanding about what guides and motivates PwS in selecting footwear and making changes with respect to footwear habits and choices.
Purpose: Foot problems and suboptimal footwear are risk factors for falls among the elderly. Footwear choice may therefore be important for people with balance impairment following stroke but little is known about their experience. This study explored foot problems experienced following stroke, factors influencing footwear choices and views of footwear in use.
Methods: Eligibility criteria were diagnosis of a stroke, able to walk and willingness to participate. Semi structured interviews with 15 people with stroke [PwS], purposively sampled from respondents to a screening survey. The sampling process drew on information about mobility (with or without falls), reliance on walking aids or other people, able to walk more than ¼ mile. Interviews were conducted in participants homes. Participants were asked to make available for discussion items of footwear currently being worn indoors and out. Data were managed and analysed thematically using Framework.
Results: The sample comprised 15 people, 8 men and 7 women ranging in age from 52-84 years; mean 71 years with varying levels of mobility. Participants typically experienced impaired mobility with balance problems and felt at risk of falling. Stroke related foot problems, including altered sensation, oedema, and foot drop, predominantly on the stroke affected side, influenced footwear priorities. Footwear choices prioritised comfort, security and convenience, sometimes in tension with concern about appearance. Challenges included choosing appropriate indoor footwear and finding shoes to accommodate orthoses and oedema. Participants highlighted perceived lack of footwear advice from health care professionals [HCPs] and variable experience of shoe shopping.
Conclusion(s): Foot problems, as well as gait and balance impairment, have implications for footwear priorities following stroke but PwS feel unsupported in making healthy footwear choices. HCPs could be trained to routinely deliver footwear assessment and advice and facilitate referrals to specialist podiatry services where appropriate.
Implications: HCPs could be trained to routinely deliver an initial footwear assessment and advice as part of stroke rehabilitation.
Funding acknowledgements: National Institute for Health Research, Research for Patient Benefit (PB-PG-01212-27001).
Topic: Neurology: stroke
Ethics approval: Full ethical approval granted (LREC: 14/SW/0078); sponsored by University Hospitals Southampton NHS Foundation Trust (R&D: RHM MED 1169).
All authors, affiliations and abstracts have been published as submitted.
