The Footwear Assessment Form: a reliable clinical tool to assess footwear characteristics of relevance to postural stability in older adults

Objective: Falls in older adults are common and may result in serious injur y. Inappropriate footwear has been suggested to be a contributing factor to many falls. However no studies have been undertaken to determine whether c linicians can reliably assess footwear variables thought to influence postu ral stability in older adults. The aim of this study was therefore to devel op a simple clinical footwear assessment form and assess its reliability, b oth between examiners and with repeated assessments over time. Design: Two examiners assessed seven footwear variables (shoe type, heel he ight, heel counter stiffness, longitudinal sole rigidity, sole flexion poin t, tread pattern and sole hardness) in 12 different shoes, and repeated the measurements three weeks later. The examiners were blinded to each other's and their own previous results. Results: Analysis using the kappa (kappa) and percentage agreement statisti cs revealed the examiners' footwear assessments to be generally highly reli able (kappa = 0.47-1.00 for inter-rester comparisons, kappa = 0.40-1.00 for intra-tester comparisons), with the exception of inter-tester assessment o f sole hardness (kappa = 0.03-0.48). Conclusion: The Footwear Assessment Form is a reliable clinical tool for th e assessment of shoe type, heel height, heel counter stiffness, longitudina l sole rigidity and tread pattern; however, a more objective protocol may b e required to improve the reliability of sole hardness evaluation. The Foot wear Assessment Form can now be used with confidence in the clinical settin g and in future investigations to determine the contribution of footwear ch aracteristics to instability and falls in older adults.