Mobility Assistive Devices Research Articles

Facilitators and barriers to perform physical activity in patients post-heart transplantation: a qualitative study.

Most patients experience barriers for becoming physical active post-heart transplantation. Therefore, identifying barriers and facilitators can help healthcare professionals in developing physical activity programs. This study aimed to explore the physical activity experiences, perceived barriers, and facilitators to perform physical activity of patients' post-heart transplantation. A qualitative study was carried out using in-depth semi-structured interviews on 24 patients post-heart transplantation from October to December 2022. The data were analyzed using an inductive strategy for finding emerging themes. NVivo 12.0 software was used to analyze the data. The physical activity experiences included that (1) patients felt that they had to adapt to a new situation after the heart transplantation, (2) walking was a popular physical activity preferably outdoors, (3) participants preferred to perform physical activity regularly with others, and (4) they felt better since they perform physical activity. The facilitators were: (1) Desire to live; (2) Experiencing physical benefits; (3) Being physically active with others; (4) Use of mobility assistive devices resources. The barriers were: (1) Feeling not being able to perform former physical activity; (2) Complications and experiencing symptoms post-heart transplantation; (3) Unfavourable climate. Patients post-heart transplantation have various facilitators influencing their post-transplant experience to perform physical activity. Key facilitators include the desire to live, physical benefits, social activity, and external support. Yet, they also face barriers like lost abilities, post-transplant complications, and environmental challenges.

Sacral U-type Fractures in Patients Older Than 65 years.

The purpose of this study was to determine the degree of disability that geriatric patients with sacral U-type fractures experience. Patients older than 65 years presenting from 2013 to 2019 with a U-type sacral fracture were included. Patient demographics, treatment type, preinjury domicile, preinjury use of assistive devices, and neurologic deficits were recorded. Outcomes included mortality, return to preinjury domicile, and use of assistive devices for mobility. Among 46 patients in the treatment period, ground-level fall was the most common mechanism of injury (60.8%). Thirty-four patients (74%) were treated surgically, most commonly with closed percutaneous fixation (n = 27). Thirteen percent of patients died during the admission. At the final follow-up, 14 (45%) had not returned to their prior domicile and 18 (58%) required more supportive assistive devices. Seventy-three percent of patients who presented delayed required a new gait aid, compared with 47% presenting acutely. Between those presenting with low-energy versus high-energy mechanisms, similar rates of need were observed for new assistive devices (50% low and 73% high) and lack of return to preinjury domicile (40% low, 50% high). Many geriatric patients were disabled by or died after sustaining a sacral U-type fracture, highlighting the morbidity regardless of high-energy or low-energy trauma.

Impact of Contextual Factors on the Perceived Participation of People With Multiple Sclerosis and Gait Impairment Using Mobility Assistive Devices: A Qualitative Analysis.

People with multiple sclerosis and gait impairment are particularly susceptible to facing restrictions in their participation. This study aims to investigate (a) which contextual factors within the framework of the International Classification of Functioning, Disability and Health (ICF) are relevant for participation from the perspective of people with multiple sclerosis and gait impairment who (intend to) use mobility assistive devices, and (b) how these contextual factors shape the subjective facets of participation, including a sense of connection, efficacy and meaning, based on the social identity approach to health and well-being. We conducted a qualitative analysis on data gathered from four online focus group interviews, each involving four to six people with multiple sclerosis and gait impairment who (intend to) use mobility assistive devices (totalling N = 19), and 12 individual online interviews conducted with participants from the focus group interviews. The analysis followed the qualitative content analysis according to Kuckartz. Mobility assistive devices such as walkers, manual wheelchairs and electric wheelchairs/scooters were seen as facilitators that enabled participation in various life situations and enhanced a sense of efficacy by promoting independence. Challenges were encountered in relation to architectural barriers, pathways, weather conditions, public transportation and the lack of integral accessibility to services and systems. Although instrumental support could ease participation, it was also associated with an impaired sense of efficacy. Attitudes, particularly developing an understanding of the experiences of people with multiple sclerosis and gait impairment from others' perspectives, were considered important but often lacking, and discriminatory attitudes were experienced. On the level of personal factors, acceptance of both the mobility assistive devices and the disease itself were seen as facilitators for maintaining involvement in life situations. This study extends the existing literature by shedding light on the interconnectedness of contextual factors within the ICF and various facets of perceived participation, including a sense of connection, efficacy and meaning. These findings provide valuable insights for stakeholders such as urban planners and policymakers in developing inclusive environments that enhance the overall quality of participation for people with multiple sclerosis and gait impairment. This study reports on the lived experiences of people with multiple sclerosis and gait impairment who (intend to) use mobility assistive devices. The research team stood in close exchange with project members of the German Multiple Sclerosis Society Lower Saxony, a group representing the interests of people with multiple sclerosis, to design and conduct the focus group interviews. The results from the focus group interviews were the basis for the design of a participatory future workshop in which people with multiple sclerosis and stakeholders involved in the healthcare process collaboratively developed recommendations for improving the provision of mobility assistive devices. German Clinical Trials Register number: DRKS00025532.

Perceived Vulnerability to Disability-Related Victimization in People With Multiple Sclerosis: Community Survey on Risk and Protective Factors.

The perception that one is at increased risk of interpersonal victimization or violence can deleteriously affect community participation and quality of life. Race, sex, and disability status, often associated with use of an assistive mobility device (AD), are known correlates of perceived risk of victimization; however, almost no research has explored how these variables intersect for individuals with multiple sclerosis (MS), and none have sought to identify potential risk and protective factors. Data for the present study come from a single time point derived from a 10-year longitudinal survey of 446 individuals with MS. Lifetime trauma exposure, personal resilience and self-efficacy, control over participation, and perceived risk of interpersonal victimization due to disability were all assessed via self-report. Statistical analyses included analysis of covariance with participants stratified by race/ethnicity, sex, and AD use. After controlling for lifetime trauma exposure and severity of physical impairment, the use of an AD was significantly associated with greater perceived risk of victimization due to disability. Further, people with MS from racial and ethnic minority groups who used ADs had the highest perceived risk relative to all other groups. Higher levels of perceived risk were associated with a lower sense of control over community participation, lower resilience, and lower disease management self-efficacy. Visible indicators of disability may contribute to perceptions of vulnerability, especially among people with MS who are racially and ethnically marginalized. Clinicians should be aware of how perceived vulnerability may impact a sense of control over community participation, particularly when educating patients on AD use.

Social and physical environment effects on toileting disability among older adults in India

BackgroundTo examine the prevalence of toileting disability among older adults in India and its association with broad aspects of the physical and social environment.MethodsWe use data from the inaugural wave of the Longitudinal Ageing Study in India and focus on adults aged 65 and older (N = 20,789). We draw on the disablement process model and existing frameworks to identify environmental factors and other risk factors that may be associated with toileting disability. Hierarchical logistic regressions are implemented to analyze the health impacts from physical and social environment characteristics.ResultsOne in five older Indian adults had difficulties with toileting, and the prevalence rate of this functional disability varied across sub-national regions. We find that low neighborhood trust was associated with an increased likelihood of toileting disability, as was the use of assistive mobility devices. The negative effects of these social and external environment characteristics hold when we stratified the sample by rural and urban residency. Also, older adults in urban areas without access to toilets and using shared latrines had higher odds of being disabled in terms of toileting. Other factors important in explaining toileting disability among older adults included poor self-rated health, arthritis, currently working, living in the East or West region, and having functional limitations.ConclusionsPoor person-environment fit can compromise older adults’ ability to perform self-care tasks. Policymakers need to look beyond the physical environment (e.g., dedicating resources to construct toilet facilities) to adopt a more holistic, multi-faceted approach in their sanitation policies. Improving the safety of neighborhood surroundings in which shared latrines are located and the availability of accessible toilets that cater to those with mobility impairments can help improve independence in toileting among older adults.

Appraising the Physical Activity Levels of Saudis with Physical Disabilities: Effects of Disability Type, Mobility Assistive Devices, and Demographic Factors.

Physical activity (PA) has numerous health benefits for individuals with physical disabilities (IWPD). However, it is common for activity levels to fall below the suggested limits. This study aimed to evaluate the prevalence, pattern, and levels of PA among IWPD in Saudi Arabia. It also investigated the effects of individuals' type of disability, mobility assistive devices, and demographic features on PA levels. Data were collected from 238 participants, mostly male (62.2%), aged 39.76 ± 12.19 years. Among them, 19.3% had spinal conditions, 14.7% had progressive muscular dystrophy, 15.1% had multiple sclerosis, 17.6% had cerebral palsy, 16.4% had poliomyelitis, and 16.8% had limb or foot amputations. The participants were assessed using the Arabic version of the Physical Activity Scale for Individuals with Physical Disabilities (PASIPD-AR). The results showed that 62.6% (64.9% of males and 58.9% of females) met the minimum PA guidelines specified by the WHO. The average PASIPD-AR score was 10.33 ± 10.67 MET-hours/day, indicating lower PA levels, and 8.4% of individuals did not participate in any form of PA. Significant discrepancies were detected in disability type and mobility assistive device use after age adjustment. Marital status, education, and occupation greatly affected PA components. Greater attention should be paid to promoting an active lifestyle among IWPD in Saudi Arabia.

Acute Knee Crutch Use Provokes Changes to Postural Strategy.

Single-leg knee crutches are a relatively new, hands-free mobility assistive device with benefits over standard axillary crutches. Our main goal in this study was to evaluate balance ability in a healthy population upon first exposure to the knee crutch device. We had 20 healthy individuals (M age = 21.1; SD = 1.5years) complete baseline static and dynamic balance tests on a force plate, followed by knee crutch fitting, a self-selected duration of ambulation practice, and another round of balance testing while wearing the knee crutch. We used the BTrackS Balance Test (BBT) to measure static balance, and the BTrackS Limits of Stability (BLOS) test to measure dynamic balance, and we created a custom lateral bias score from the BLOS results. On average, participants self-selected 3.1minutes of ambulation practice. Wearing the knee crutch caused a near doubling of static balance path length and a large reduction in percentile ranking on the BBT. Dynamic balance area was more than halved (p < .001), with lateral bias scores during the BLOS, indicating that participants heavily favored their non-crutched leg (p < .001). Our results indicate that static and dynamic balance were significantly altered when wearing the knee crutch, and participants seemed to switch to a single leg stance strategy. Despite these balance changes, participants were quickly ready and willing to complete independent ambulation and balance testing procedures using the single-leg knee crutch.

Elastic energy-recycling actuators for efficient robots.

Electric motors are widely used in robots but waste energy in many applications. We introduce an elastic energy-recycling actuator that maintains the versatility of motors while improving energy efficiency in cyclic tasks. The actuator comprises a motor in parallel with an array of springs that can be individually engaged and disengaged, while retaining stored energy, by pairs of low-power electroadhesive clutches. We developed a prototype actuator and tested it in five repetitive tasks with features common in robotic applications but difficult to perform efficiently. The actuator reduced power consumption by at least 50% in all cases and by 97% in the best case. Elastic energy recovery, controlled by low-power clutches, can improve the efficiency of mobile robots, assistive devices, and other engineered systems.

Psychosocial predictors of mobility assistive devices non-adherence among older adults

Background: Mobility assistive devices (MADs) provide support to older adults to improve their quality of life; however, research shows that as many as 75% of older adults are non-adherent to prescribed MADs. This study investigated the psychosocial factors that predict non-adherence to MADs among older adults.Methods: A sample of Canadian older adult MADs users who resided in a long-term care facility was included. The data was collected using the Psychosocial Impact of Assistive Devices Scale (PIADS), and the Medical Outcomes Study Social Support Survey (mMOS-SS). Data analysis was performed using SPSS 28. Descriptive statistics were used to describe the sample and the study variables. Pearson correlation coefficients were used to evaluate the association between the study variables. Variables that were associated with non-adherence in a univariate analysis were subsequently entered into a multiple regression analysis.Results: The sample comprised 48 residents (26 females and 22 males), with a mean age of 86.8. In the univariate analysis, scores from the three PIADS subscales, namely, Competence, Adaptability, and Self-esteem, and the Social Support scale were significantly correlated with non-adherence (p < 0.05). In the multiple regression analyses, only Self-esteem significantly predicted non-adherence (p < 0.05), and this model explained between 43.5 and 54.3% of the variance in non-adherence.Conclusion: This study revealed that the Self-esteem construct, which includes several concepts related to psychological well-being, was the only significant predictor of non-adherence among the studied sample of older adults. The clinical implications of the findings are subsequently discussed.

Evaluation of functionality-mobility in patients with skeletal dysplasias. Application of the STEMS tool ("everyday symptoms and mobility screening tool for skeletal dysplasias").

Individuals with differing forms of skeletal dysplasias (SD) frequently report impaired mobility and symptoms. With the objetive to evaluate mobility and associated symptoms in people with SD at an Argentinian pediatric hospital, using an Argentinian version of the Screening Tool for Everyday Mobility and Symptoms (STEMS), a simple questionnaire that allows clinicians to quickly identify the presence of symptoms associated with mobility in people with SD, while considering different environmental settings and the use of assistive devices, an analytical study of a consecutive sample of patients older than 5 years with SD and their affected relatives was carried out.Diagnosis, comorbidities, socioenvironmental, therapeutic, auxological and mobility variables were recorded. The presence and intensity of symptoms was noted through use of both the STEMS and validated scales. Descriptive, association and correlation analyzes were performed. One hundred and nineteen individuals with SD were enrolled in the study and divided into groups: Osteogenesis Imperfecta (OI, n = 55), Achondroplasia (ACH, n = 36) and Other SD resulting in disproportionate short stature (n = 28). Mobility assistive devices were almost exclusively used by individuals with OI. They were more frequently used by individuals with overweight and obesity, more severe form of the disease and in the outdoor settings. Two thirds (66.4%) of the individuals assessed in this study reported pain, 87.4% reported fatigue, and 58.8% reported both pain and fatigue. The intensity of symptoms was similar between groups and correlated with age and auxological variables. The STEMS was clear, easy and quick to use for identifying presence of pain and fatigue in this population group. The STEMS proved to be a simple and useful tool for evaluating functional mobility and associated symptoms in our population of individuals with SD.

Relationship between Gait Speed and Balance Among Older Adults Residing in Long Term Care Settings

Introduction: Studies have documented that a decrease in gait speed is linked to an increased risk of falling among older adults residing in the community. However, there is a lack of research examining the correlation between gait speed and balance in older adults who reside in long-term care settings (LTCS). Objective: To determine the relationship between balance using a four-square step test (FSST) and gait speed using a 10-m walk test among older adults residing in LTCS in and around Udupi-Manipal. Methods: A cross-sectional study was conducted among older adults residing in six LTCS. The residents above 60 years, either gender, able to follow commands, with functional vision and duration of stay &gt; 6 months were included, and those who were bed or wheelchair-bound, use assistive devices for mobility, any acute cardiovascular events in the past 3 months, any orthopaedic or neurological conditions that affect mobility, and with benign paroxysmal positional vertigo were excluded. The participants were asked to perform the FSST and gait speed test. The demographic characteristics were summarized using descriptive statistics. Linear regression analysis was carried out keeping balance as the outcome variable and gait speed as the independent variable. Results: A total of ninety-four residents were screened, and thirty-five (n=35) were included in the study. The mean age of participants was 74.94 ± 7.54 years, with an average duration of stay in LTCS being 5.37 years. The participant's average gait speed was 0.994 ± 0.325 m/s, and the average time taken to complete the balance test was 12.75 ± 4.41 sec. The regression analysis revealed that for every second decline in gait speed, the dynamic balance assessed by the FSST reduced by 0.036 seconds (r2 =0.443; p = 0.008; 95% CI: -.062, -.010). Conclusion: This study showed that with an increase in gait speed, the time taken to complete the balance test decreased. This suggests older adults have better balance abilities when they can walk at a faster speed.

Myotonic Dystrophy Type 1: A Comprehensive Literary Review

Myotonic Dystrophy Type 1 (DM1) is a degenerative neuromuscular disease that costs 448 million dollars in the US annually to combat. Caused by the abnormal expansion of the CTG sequence located along the Dystrophia Myotonica Protein Kinase (DMPK) gene of chromosome 19, DM1 results in several different observable effects that include, but are not limited to cataracts, facial weakness, hypersomnia, cardiomyopathy, and arrhythmias. Symptoms are attributed to the rapid degeneration of muscles that leads to weakened control over the heart, lungs, gastrointestinal systems, and face. Treatments for DM1 are limited to minimizing morbidity such as through assistive mobility devices. In pursuit of a cure, pre-clinical models have provided a foundation for deeper investigations into the pathogenesis of DM1. Ongoing studies utilize molecular genetics and pharmacology to target the underlying molecular mechanisms, fortunately, many of these studies have shown potential in pre-clinical trials. Antisense therapy targets expanded trinucleotide regions and has demonstrated recovery of cardiac muscle in mice. CRISPR/SpCas9, when injected, has shown beneficial effects in several DM1 animal models. Furthermore, given the pre-clinical success of the novel pharmacologic agent AOC 1001, clinical trials have been initiated and are ongoing. Unfortunately, due to the nuances and difficulties in treating DM1, there is currently no Food and Drug Administration-approved disease-modifying therapies, and as such DM1 represents a growing public health concern.

Smart Quality Decision-Making Model for Mobile Assistive Devices

With the gradual maturity of the Internet of Things environment, the collection and analysis technology of production data is continuously improved, and the improvement of product process quality and safety performance can not only increase product value but also prolong product life, in order to achieve the goal of energy-saving and waste-reducing green production. Therefore, this study used process capability indicators of important quality characteristics as evaluation tools for the manual wheelchair products and proposed a smart quality decision-making model for production data. First, we constructed an evaluation index for the important quality characteristics of the carbon fiber wheel rims to verify that each important quality characteristic can meet the required quality level. Next, based on the upper confidence limit of the evaluation index, the fuzzy decision index and fuzzy testing rules were established. In addition, the decision-making index was converted into the index observation value, and an intuitive fuzzy evaluation rule more convenient for practical application was established. Finally, we employed an easy-to-use radar evaluation chart to assess whether the index fell into the improvement range and decide whether to improve. In conclusion, this study considers the need of businesses for quick their responses to decision-making. The fuzzy testing design built on upper confidence limits can incorporate past data experience. It can still maintain the testing accuracy for small-sized samples. At the same time, it can also help enterprises pursue smart manufacturing and management and realize the business philosophy of sustainable development.

Hurdling Barriers: Exploring Inaccessibility in Higher Education Institutions for Mobility Assistive Device Users

This article explores the challenges faced by students with disabilities using mobility assistive devices (i.e. wheelchairs or crutches) in a large public sector urban higher education institution. Cities are characterized by rapid pace and complex infrastructure including buildings, roads, and public spaces that present unique obstacles that hinder these individuals' mobility and overall experience. For this qualitative study, the locale chosen was a large public sector university, and data was collected from 10 students with disabilities who use wheelchairs and other mobility assistive devices and reside in the campus student accommodation. The data was collected through in-depth interviews and analyzed using thematic analysis. The findings indicate that the infrastructure on campus is not accommodating for students with disabilities who use mobility aids, which directly and indirectly impacts their educational experiences. In addition, the university lacks a uniform policy for providing services and allocating resources for students with disabilities. The participants believe that the university is indifferent to their needs; however, the facilities and behaviors within departments vary and at times can be quiteenabling. This study contributes to the ongoing dialogue on enhancing accessibility, inclusivity, and equity within our urban educational landscapes.

Hurdling Barriers: Exploring Inaccessibility in Higher Education Institutions for Mobility Assistive Device Users

This article explores the challenges faced by students with disabilities using mobility assistive devices (i.e. wheelchairs or crutches) in a large public sector urban higher education institution. Cities are characterized by rapid pace and complex infrastructure including buildings, roads, and public spaces that present unique obstacles that hinder these individuals' mobility and overall experience. For this qualitative study, the locale chosen was a large public sector university, and data was collected from 10 students with disabilities who use wheelchairs and other mobility assistive devices and reside in the campus student accommodation. The data was collected through in-depth interviews and analyzed using thematic analysis. The findings indicate that the infrastructure on campus is not accommodating for students with disabilities who use mobility aids, which directly and indirectly impacts their educational experiences. In addition, the university lacks a uniform policy for providing services and allocating resources for students with disabilities. The participants believe that the university is indifferent to their needs; however, the facilities and behaviors within departments vary and at times can be quite enabling. This study contributes to the ongoing dialogue on enhancing accessibility, inclusivity, and equity within our urban educational landscapes

Mobility Compensatory Strategies in Individuals With Multiple Sclerosis (A Qualitative Study)

Background and Objectives: The complications and motor disorders caused by multiple sclerosis (MS) not only affect the individual’s movement abilities but also play a crucial and valuable role in how these individuals carry out their daily activities. In this way, patients with MS use certain compensatory methods, depending on individual differences, their environment, and their family’s support, to help with the complications of this disorder. For this reason, this study aims to identify the compensatory strategies that people with MS use to adapt to their mobility limitations. Methods: In this study, 13 patients with MS (7 women and 6 men), with informed consent, an average age of 43 years, and a qualitative content analysis approach, were included in the study. The sampling was performed purposefully with maximum variation, and the data was collected via quasi-structured in-depth interviews. Immediately after each interview, the data was analyzed using Cheevakumjorn`s method. Results: After analyzing the data and extracting the resulting codes, the codes were classified according to their similarities and differences. Ultimately, three main components of “compensatory strategies for home mobility”, “compensatory strategies for outdoor mobility”, and “compensatory strategies for carrying out daily activities” were formed. Conclusion: Although families play a major role in compensating for the mobility problems of these patients, it is necessary for health providers to reduce the burden placed on their families, and to educate MS people on self-care and adjust their living environment. Furthermore, providing mobility assistive devices for the patients should be done according to their differences and their environment.

Reverse Shoulder Arthroplasty in Upper Extremity Ambulators: A Matched-Cohort Analysis.

Upper extremity ambulators (UEA) who require prolonged use of assistive devices for mobility have a high incidence of shoulder pathology secondary to increased stress across the shoulder joint with upper extremity weight bearing. Reverse shoulder arthroplasty (RSA) for rotator cuff arthropathy (RCA) has historically been associated with increased complications in UEA, but more recent studies have shown more promising outcomes. The objective of this study is to evaluate clinical outcomes and complication rates between these two groups to define the relative risk of RSA in the UEA population and identify opportunities to improve treatment outcomes. An IRB-approved retrospective chart review was performed in patients that underwent RSA at our institution by the senior author from 2004-2019. UEA were defined as patients that used regular upper extremity assistive devices for community ambulation prior to initial consultation for the surgical extremity. Pre- and postoperative range of motion (ROM), Visual Analog Scale scores, American Shoulder and Elbow Surgeons (ASES) scores, Constant Murley scores, and Simple Shoulder Test (SST) scores were measured at defined intervals. Complications including infection, instability and need for revision surgery were also compared. All patients were followed for a minimum of two years postoperatively. A total of 159 RSA procedures (70 UEA, 89 controls) were performed during the study period. On average, UEA patients had more preoperative pain and less shoulder function than controls, with statistically significant differences in Visual Analog scores (6.897 vs. 5.532, p=0.0010) and ASES scores (33.50 vs. 40.20, p=0.0290), respectively. Despite the lower baseline values, UEA patients experienced excellent postoperative improvement, leading to similar postoperative pain and shoulder function except for a lower average forward flexion in the UEA group (126.76° vs. 135.45°, p=0.0354). Notching and complication rates were also similar between the two groups, with notching rates of 59% and 50% and complication rates of 14.3% and 13.5% in the UEA and control groups, respectively. RSA in the UEA population can achieve similar pain and functional outcomes as compared to age-matched controls without a significant increase in complication rates; however, further studies are required to assess long-term comparative outcomes in this challenging patient population.

Willingness of people with severe visual impairments to accept new transportation assistive technologies

BACKGROUND: Technology-driven assistive devices provide numerous benefits to people with severe visual impairments, yet device take-up rates are often low. OBJECTIVE: The study sought to determine the strengths of connections between transportation self-efficacy, technophobia, personal inertia, innovation resistance, and willingness to adopt high-tech transportation assistive devices among visually impaired individuals. It also examined certain potential barriers to device acceptance; namely the perceived safety and complexity of assistive devices and the effects on a person’s self-image of using a device. METHODS: A model was developed and tested via a questionnaire survey of 319 people with visual disabilities, each of whom was presented with five examples of hypothetical high-tech mobility and transportation assistive devices. RESULTS: Technophobia exerted a powerful negative impact on innovation resistance and was itself significantly determined in part by transportation self-efficacy. Personal inertia and the effects of device use on self-image failed to impact significantly on the participants’ levels of innovation resistance. CONCLUSIONS: The results have implications for the promotional activities of manufacturers of mobility and transportation assistive devices and for visual disability support organisations that wish to secure acceptance of new assistive devices.

Outcomes of uncomplicated assistive devices with older people: A pretest-post-test intervention study in a small community

BACKGROUND: Only a few studies have investigated the effects of assistive devices (ADs) from the user’s perspective. This knowledge is important for clinical and policy decision-making. OBJECTIVE: The aim was to determine to what extent older people experience less difficulty in performing daily activities after having received uncomplicated ADs such as bath chairs and rollators. METHODS: The study had a pretest – post-test intervention design where the outcomes were evaluated using the Individually Prioritized Problem Assessment (IPPA) and analyzed with paired t-tests. Effect sizes (ES) were interpreted according to Cohen’s d. People aged ⩾ 67 years with sufficient cognitive or hearing functioning necessary to participate in an interview were included. RESULTS: This study enrolled 52 home-dwelling persons aged 69–93 years. Baseline IPPA score was 17.29 ± 4.27 points (mean ± standard deviation), follow-up score 9.29 ± 4.47 points, indicating a significant reduction in the mean difficulty score of 8.64 points (95% confidence interval: 7.37–9.81 points) (p⩽ 0.001). The ES at the group level was 1.57 and varied from no to large effect. CONCLUSIONS: Receiving uncomplicated ADs significantly reduced the difficulties experienced by older people. However, the large variations in the ES highlight the importance of providing individually tailored training programs for mobility ADs, which should be considered in further outcome studies.

Safety Concerns in Mobility-Assistive Products for Older Adults: Content Analysis of Online Reviews.

Older adults who have difficulty moving around are commonly advised to adopt mobility-assistive devices to prevent injuries. However, limited evidence exists on the safety of these devices. Existing data sources such as the National Electronic Injury Surveillance System tend to focus on injury description rather than the underlying context, thus providing little to no actionable information regarding the safety of these devices. Although online reviews are often used by consumers to assess the safety of products, prior studies have not explored consumer-reported injuries and safety concerns within online reviews of mobility-assistive devices. This study aimed to investigate injury types and contexts stemming from the use of mobility-assistive devices, as reported by older adults or their caregivers in online reviews. It not only identified injury severities and mobility-assistive device failure pathways but also shed light on the development of safety information and protocols for these products. Reviews concerning assistive devices were extracted from the "assistive aid" categories, which are typically intended for older adult use, on Amazon's US website. The extracted reviews were filtered so that only those pertaining to mobility-assistive devices (canes, gait or transfer belts, ramps, walkers or rollators, and wheelchairs or transport chairs) were retained. We conducted large-scale content analysis of these 48,886 retained reviews by coding them according to injury type (no injury, potential future injury, minor injury, and major injury) and injury pathway (device critical component breakage or decoupling; unintended movement; instability; poor, uneven surface handling; and trip hazards). Coding efforts were carried out across 2 separate phases in which the team manually verified all instances coded as minor injury, major injury, or potential future injury and established interrater reliability to validate coding efforts. The content analysis provided a better understanding of the contexts and conditions leading to user injury, as well as the severity of injuries associated with these mobility-assistive devices. Injury pathways-device critical component failures; unintended device movement; poor, uneven surface handling; instability; and trip hazards-were identified for 5 product types (canes, gait and transfer belts, ramps, walkers and rollators, and wheelchairs and transport chairs). Outcomes were normalized per 10,000 posting counts (online reviews) mentioning minor injury, major injury, or potential future injury by product category. Overall, per 10,000 reviews, 240 (2.4%) described mobility-assistive equipment-related user injuries, whereas 2318 (23.18%) revealed potential future injuries. This study highlights mobility-assistive device injury contexts and severities, suggesting that consumers who posted online reviews attribute most serious injuries to a defective item, rather than user misuse. It implies that many mobility-assistive device injuries may be preventable through patient and caregiver education on how to evaluate new and existing equipment for risk of potential future injury.