Implementation of the enhanced paper grip test in podiatric practice: A clinical audit of feasibility and association with recent falls.

BACKGROUND

Falls in older adults remain a major clinical concern. Although the Enhanced Paper Grip Test (EPGT), provides an objective measure of lower limb strength and has shown promise in controlled settings, its use in routine podiatric practice has not been described.

AIM: To audit the implementation of the EPGT in routine private podiatric practice and to explore whether EPGT measures are associated with self-reported recent falls in older adults.

METHODS

The EPGT was introduced on a trial basis in three independent private UK podiatry clinics for six months. People (aged ≥60 y) were tested when the treating podiatrist considered the assessment clinically appropriate. Anonymised routine clinical data were extracted retrospectively at the end of the audit period, including EPGT outcomes, age, sex, and self-reported history of an unexplained fall in the previous twelve months.

RESULTS

Seventy-eight participants (mean age 72 ± 7 years) were assessed; 17 reported a fall. Median EPGT force was statistically significantly lower in fallers (11.9 N) than in non-fallers (21.4 N), U= 283,z = -3.554,p < .0005. Differences remained significant after adjustment for age and sex and were robust to outlier exclusion. Hallux-related pathology was not associated with EPGT outcomes.

CONCLUSIONS

In this pragmatic private practice audit, the EPGT could be incorporated into routine podiatric assessment and lower EPGT values were associated with self-reported recent falls. These findings support the EPGT as a potentially useful adjunct to falls risk screening that could be offered as part of routine podiatry care. Prospective studies are needed before predictive use or clinical thresholds can be established.