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2016-2018: Are older people putting themselves at risk of falling when using a walking frame? – Dunhill Medical Trust

Walking aids are prescribed to those intrinsically prone to falling with the aim of improving stability and mobility. However, their prescription alone does not eliminate risk of falling; indeed, somewhat paradoxically, their reported use has been associated with falls. For example, a meta-analysis associated walking aid use with a 2-3 fold risk of falling. Whilst correlation cannot be assumed to indicate causation, this is certainly of serious concern and justifies further research. The effectiveness of walking aids clearly depends on how appropriately they are prescribed and used, yet little guidance is offered to users and how stable users are in real life situations is entirely unknown. The lack of standardized methods for assessment of walking aid stability is reflected in an absence of evidence-based practice around training and prescription.

Interestingly, the vast majority of biomechanics research concerned with gait stability has been on unassisted walking. This is surprising, given the high prevalence of walking aid use in the most vulnerable (older old), and because walking with a frame differs significantly from unassisted walking in a number of ways. These include the need to coordinate the movements of the device together with body and foot movements, and significant changes to the base of support over the ‘gait cycle’, both of which make the direct use of unassisted stability measures inappropriate.

To bridge this gap in the knowledge base we previously developed a “Smart Walker” (Salford Walking Aid System [SWAS]) and associated software for assessment of walking frame user stability (1). We are pleased to now have received funding worth £74,907 from the Dunhill Medical Trust for a study that uses the Smart Walker in home-settings, to gather the first-ever benchmark data on 30 older adults’ stability with a walking frame. Further, we will consult stakeholders (clinicians as well as manufacturers) on how the Smart Walker Technology may be used to improve care. The work is carried out in collaboration with Oxford Brookes University.

Dunhill Project

Smart Walker System including walking frame with integrated load cells, force sensing insoles in the user’s shoes, and 3D optoelectronic cameras.

1. Costamagna E, Thies S, Kenney L, Howard D, Liu A, Ogden D. A generalizable methodology for stability assessment of walking aid users. Med Eng Phys 2017; 47: 167-175.