Assistive technologies

BACKGROUND

Counter-intuitively, a systematic review identified general walking aid use to be a risk factor for falling; some research even linked falls directly to use of walking aids. Hence walking aids’ effectiveness remains suboptimal. Yet a lack of innovation, especially with regard to indoor walking frames, persists: the front-wheeled Zimmer frame has not changed in design for decades. It was the aim of this work to completely re-think and innovate indoor walking frame design for enhanced user stability and mobility. New features include: 1) swivel wheels at the front to help turning, but which self-align straight during straight line walking, 2) glider feet at the rear to go over thresholds, 3) brakes inside the glider feet to prevent the frame from “running away”.

METHODS

Four proof-of-concept studies investigated the standard versus the new frame design:

Study 1. A gait lab-based study quantified stability (9 healthy older adults, walking repeated trials).

Study 2. A care-home based study investigated unstable usage patterns and body weight transfer (9 older frame users).

Study 3. An interview study investigated perceptions of 7 frame users regarding usability and safety.

Study 4. A clinical trial assessed safety and efficacy of use (10 clinicians, 10 inpatients, 8 outpatients, use of a questionnaire).

RESULTS

The novel frame increased stability during performance of complex everyday tasks (p<0.05). It also facilitated safer usage patterns whilst providing greater and more continuous body weight support. Users found the new design enjoyable; “That’s better than what I am using at the moment” and “I enjoyed using this one {new frame} compared to the other.” and clinicians perceived it to be safe and effective and hence more usable.

CONCLUSIONS

The four studies combined let us conclude that the new frame design is an improvement on the status quo.

Background: Foot pain in older adults may reduce physical activity, resulting in impaired mobility and an increased risk of falls. Orthotics, both with and without a metatarsal pad, may provide foot pain relief and improved stability. Objective: Compare the use of Aetrex orthotics with and without a metatarsal pad in decreasing pain and fear of falling in older adults. Methods: 206 participants over 60 years old were randomised into the intervention group, who received Aetrex L2305 Orthotics with a metatarsal pad, or the control group, who received Aetrex L2300 Orthotics with no metatarsal pad. At baseline and 6-week follow-up, musculoskeletal pain was reported via Numerical Rating Scales (NRS), foot pain and functionality via the Foot Health Status Questionnaire (FHSQ), and fear of falling via the Short Falls Efficacy Scale International. Results: Both groups reported significant improvements in pain in the back, hips, knees, ankles, and feet using the NRS (P < 0.001). Using the FHSQ, foot pain significantly improved in both the intervention (x̄= 18.47 ±20.58, P < 0.001) and control group (x̄= 17.21 ±18.74, P < 0.001). Function also improved significantly in both groups (x̄= 18.35 ±20.67, P < 0.001 and x̄ = 15.07 ±20.15, P < 0.001, respectively), as did fear of falling (x̄= 1.55 ±3.79, P < 0.001 and x̄= 1.23 ±3.53, P < 0.001, respectively). No statistically significant difference was observed between groups for any outcome (P > 0.05). Conclusion: Aetrex orthotics, with and without metatarsal pads, decrease pain and fear of falling in older adults.