Principal Investigator: Dr Sibylle Thies
Lead institution: University of Salford
Award amount: £74,907
Example of a front-wheeled walker.
Smart Walker system (example of a front-wheeled walker): walking frame with integrated load cells and pressure-sensing insoles in user’s shoes for home assessments, and additionally using 3D optoelectronic cameras for gait lab and ADL flat assessments.
Are older people putting themselves at risk of falling when using a walking frame?
Walking aids such as walking frames are prescribed to older people with the aim of improving stability and mobility; however, paradoxically their use has been associated with an increased risk of falling. Despite this worrying finding, there is limited guidance available for older people on how best to use these walking aids and the evidence base underpinning the guidance, including whether people followed clinical guidance in their home environments.
Dr Thies and her team were awarded a grant in 2016 to improve understanding of walking frame use, in particular, how they were used in real-life situations. The project built on earlier work by the team to develop a Smart Walker system which could be used to evaluate the stability of walking aid users. The two main aims of the project were to:
- Measure the ways in which people walked with their frame and how stable older people were when using frames in home settings.
- Evaluate views of clinical staff, walking frame manufacturers and walking frame users on current walking frames and how Salford’s Smart Walker system (see photo), could be used in design, research and clinical practice.
Dr Thies and her team carried out 18 home assessments. They found that in the home environment people commonly walked with their frames in ways that were not in accordance with current guidelines. The reason for this could be that users were unaware or had forgotten guidance previously received. However, videos taken by the research team also highlighted that features of the home environment made it difficult, and at times impossible, to follow the guidance. For example, door thresholds, confined spaces and clutter, as well as design features of the walking frames all appear to present challenges to the user. These findings raise questions, including whether current guidance is sufficient and/or frame designs are optimised for home-use.
To investigate the findings further, a subset of 10 participants were assessed in both the university’s Activities of Daily Living (ADL) flat and the gait laboratory. The team collected the first-ever set of objective, quantitative data on stability when using walking frames in both a home-setting (ADL flat) and the gait lab. The team found that there was an association between users following clinical guidance on how to use a walking frame and improved measures of stability. However, consistent with the observations in the real home environments, sometimes people did not use their walking frame according to guidance. Although the team has yet to establish a relationship between patterns of walking aid use and falls, it is clear that further research is needed to investigate how everyday tasks in home environments may be performed more safely.
The research team also held two focus groups: one with users of walking frames and one that included clinicians with experience in prescribing walking frames. Users of walking frames voiced a strong need for walking frames, to get ‘out and about’. However, they also had safety concerns when walking with their device. The Smart Walker system was generally perceived positively by them. Healthcare professionals prescribing walking frames revealed that no gold-standard approach exists for walking frame prescription and training of users. They rely on their clinical experience when judging the user’s safety and walking performance. They also demonstrated awareness of the challenges present in home environments. Regarding the Smart Walker system, attendees thought it would be particularly valuable in rehab settings, and to train healthcare professionals. Some issues with usability were raised, providing direction to future design work to meet the clinical needs.
The research team also explored the industry perspective with a manufacturer and NHS supplier of walking frames. They saw significant potential in the Smart Walker system and Dr Thies is currently exploring collaboration possibilities.
The Smart Walker system has the potential to:
- Inform clinical guidance.
- Enable evidence-based training and monitor walking aid users.
- Inform the design of safer next-generation walking frames.
However, further simplification of the system is required for it to become an attractive tool for home, clinical and industry settings.
This project addressed an important and under-researched matter. The team believes it to be the largest biomechanics-based study of walking aid users, the first to use a rigorous measure of stability, treating the user and their walking aid as a single system and the first to investigate participants’ behaviours in both laboratory and home environments.
Informed by their research to date and based on feedback from healthcare professionals, the project team have now developed two guidance documents concerned with the safer use of walking frames: 1) a Safety Information Leaflet for users of front-wheeled walking frames; and 2) a Good Practice Guide for those involved in prescribing these frames and training users. An associated training video has been created alongside each guidance document, and all of the resources can be found on this webpage.
Co-applicants were: Professor Malcolm Granat, Professor Laurence Kenney, Professor Dave Howard, Professor Helen Dawes and Mrs Joanne Webb. Dr Alex Bates was the Research Fellow on the project.