2 Feet 4 Life : feasibility of a foot care self-management intervention for older adults without diabetes

Abstract

[ACCESS RESTRICTED TO THE UNIVERSITY OF MISSOURI AT REQUEST OF AUTHOR.] Foot problems are prevalent, impact over 30% of older adults, and can lead to loss of function, falls, and hospitalization. This pilot intervention study, based on Social Cognitive Theory, evaluated the feasibility, acceptability and preliminary efficacy of the 2 Feet 4 Life foot care self-management intervention on foot care knowledge, self-efficacy, self-management behaviors, foot pain and foot health. Thirty-two non-diabetic, community-dwelling older adults were recruited from two senior centers. One community center was randomized to receive the Intervention; the other served as Control. Within the Control group, participants were randomized into two subgroups: True Control and Bias Control. The 2 Feet 4 Life intervention consisted of one hour sessions for four consecutive weeks. Assessments occurred at baseline, one month, four months and seven months. Study recruitment and retention goals were met (90.6% retention rate). The intervention was safely and accurately implemented within the anticipated timelines. Although some participants reported difficulties with select vocabulary used on one or more the patient-reported outcome tools, participants found the intervention content valuable and session length and frequency acceptable. Modest improvements in foot care knowledge, foot care behaviors, and foot health were observed in the Intervention group. Based on our analysis, the estimated between group effect size of 2 Feet 4 Life intervention appears to be large for foot care knowledge, self-efficacy, and behaviors. Our findings suggest that the patient-reported and provider-reported outcome tools used in this study require further refinement and psychometric testing. Future fully powered studies need to include diverse samples of older adults with greater variability in foot health and foot pain.