Participant-Reported Reductions in Falls and Fall-Related Injuries Associated With Variable-Friction Footwear: Retrospective Pre-Post Survey Study.

BACKGROUND: Falls represent a critical public health burden in older adults and individuals with neurological disabilities, but evidence for passive footwear-based fall prevention strategies remains limited. OBJECTIVE: This study aimed to evaluate changes in fall frequency and fall-related outcomes following adoption of variable-friction (VF) footwear. METHODS: This retrospective pre-post observational study used self-reported survey data collected from community-dwelling adults aged 18 years or older who had worn VF footwear for 3 months or longer. Participants were recruited from a convenience sample of 14,570 invited customers who purchased the device through an electronic survey platform. Outcomes included self-reported fall frequency, injurious falls, fall mechanisms, fall-related health care use (including medical visits, urgent care, and hospitalization), and assistive device use, assessed before and during VF footwear use. RESULTS: A total of 706 participants completed the survey, yielding 705 participants with usable data for analysis (4.8% response rate). Mean monthly participant-reported falls decreased from 2.4 (SD 4.3) before VF use to 0.3 (SD 1.9) during VF use (87.1% reduction; Wilcoxon signed-rank test, P<.001). The proportion reporting zero falls increased from 22.7% to 84.4%. Among participants with at least 1 fall before VF use (n=545), 95.4% (n=520) reported a reduction, including 80.7% (n=440) reporting zero falls during VF use. Injurious falls decreased by 93.2% (P<.001). Participants requiring medical attention decreased from 192 (27.2%) to 12 (1.7%; 93.8% reduction; P<.001), and hospital or urgent care visits decreased from 131 (18.6%) to 10 (1.4%; 92.4% reduction; P<.001). Trip-related falls decreased from 52.3% to 31.5% of reported mechanisms among participants who reported a fall mechanism in both periods (P<.001). Assistive device use decreased from 70.8% to 16.6% (P<.001). Mean annualized insurance-related fall costs decreased from US $5946.2 to US $45.7 per person-year (99.2% reduction) across the full cohort. CONCLUSIONS: VF footwear use was associated with substantial reductions in self-reported falls, injurious falls, and fall-related health care use. Reductions in trip-related falls are consistent with the proposed biomechanical mechanism of the device. Given the low survey response rate and potential for self-selection bias, these findings should be considered preliminary. Prospective controlled studies are needed to confirm these findings.