Rollator Use Research Articles

Test-retest reliability, construct validity and determinants of 6-minute walk test performance in adult patients with asthma

Introduction and objectivesCurrent knowledge regarding the measurement properties of the 6-minute walk test (6MWT) in patients with asthma is limited. Therefore, the aim of this study was to assess the test-retest reliability, measurement error and construct validity of the 6MWT and identify determinants of 6-minute walk distance (6MWD) in patients with asthma. Patients and methods201 asthma patients referred for pre-pulmonary rehabilitation assessment, were retrospectively analyzed (age 61±12 years, 42% male, FEV1 78±27% predicted). Patients performed two 6MWTs on subsequent days using a 30 m straight walking course. Other measurements included resting dyspnea, maximal exercise capacity, body composition, pulmonary function, pulmonary and quadriceps muscle strength and symptoms of anxiety and depression. Measurement error (absolute reliability) was tested using standard error of measurement (SEM), minimal detectable change at 95% confidence interval (MDC95%) and Bland and Altman 95% limits of agreement, whereas test-retest reliability (relative reliability) and construct validity were assessed using the intra-class correlation coefficient (ICC2,1) and correlations, respectively. ResultsThe 6MWD showed excellent test-retest reliability (ICC2,1: 0.91). The mean change in 6MWD after the second 6MWT was 18m (95%CI 11–24m), with 73% of the patients walking further in the second test. The SEM and MDC95% for the 6MWT were 35 m and 98 m, respectively. The best 6MWD correlated strongly with peak oxygen uptake during CPET and resting dyspnea (r = 0.61–0.64) and had no-to-moderate correlations with body composition, pulmonary function, respiratory and quadriceps muscle strength and symptoms of anxiety and depression (r = 0.02-0.45). Multiple linear regression was able to identify maximal workload, BMI, rollator use, maximal expiratory pressure, FEV1 and DLCO as independent determinants of the best 6MWD (R2 = 0.58). ConclusionsThe 6MWT was considered to be reliable and valid in patients with asthma, which strengthens its clinical utility. However, the majority of patients demonstrated a considerable learning effect in the second 6MWT, providing a strong rationale for performing two 6MWTs.

Validity of the Activities-specific Balance Confidence Scale in individuals with chronic obstructive pulmonary disease

ABSTRACT Background Limited research assessed the validity of the Activities-specific Balance Confidence, ABC) Scale in individuals with chronic obstructive pulmonary disease, COPD) at risk of falls. We report on the scale’s construct and criterion validity. Methods Construct validity was established by assessing known groups, convergent, and divergent validity. A receiver operating characteristic, (ROC) curve and logistic regression examined the criterion validity of the scale. Results In 223 individuals with COPD, the ABC Scale significantly, (p < 0.001) discriminated between groups, with lower scores for females [Mean difference (MD) = 10%], rollator use [MD = 13%], and fallers [MD = 12%], and had a strong association [r = 0.58, p < 0.001] with Berg Balance Scale. The scale distinguished fallers from non-fallers with a cutoff value of 58% [Area Under the Curve = 0.64, 95% CI = 0.57–0.72, p < 0.001] and significantly identified fall status [B, SE = −0.03, 0.01, p < 0.001] with an odds ratio of 0.97 [95%CI = 0.96–0.99]. The sensitivity, specificity, and test accuracy were: 61, 58, and 60%, respectively. Conclusion The ABC Scale showed evidence for known groups, convergent, and divergent validity and can assist in identifying fall status in individuals with COPD.

Assessing the concurrent validity of a gait analysis system integrated into a smart walker in older adults with gait impairments

Objective: To assess the concurrent validity of a smart walker–integrated gait analysis system with the GAITRite® system for measuring spatiotemporal gait parameters in potential users of the smart walker. Design: Criterion standard validation study. Setting: Research laboratory in a geriatric hospital. Participants: Twenty-five older adults (⩾65 years) with gait impairments (habitual rollator use and/or gait speed <0.6 m/s) and no severe cognitive impairment (Mini-Mental State Examination ⩾17). Main measures: Stride, swing and stance time; stride length; and gait speed were simultaneously recorded using the smart walker–integrated gait analysis system and the GAITRite system while participants walked along a 7.8-m walkway with the smart walker. Concurrent criterion-related validity was assessed using the Bland–Altman method, percentage errors (acceptable if <30%), and intraclass correlation coefficients for consistency (ICC3,1) and absolute agreement (ICC2,1). Results: Bias for stride, swing and stance time ranged from −0.04 to 0.04 seconds, with acceptable percentage errors (8.7%–23.0%). Stride length and gait speed showed higher bias (meanbias (SD) = 0.20 (0.11) m; 0.19 (0.13) m/s) and not acceptable percentage errors (31.3%–42.3%). Limits of agreement were considerably narrower for temporal than for spatial-related gait parameters. All gait parameters showed good-to-excellent consistency (ICC3,1 = 0.72–0.97). Absolute agreement was good-to-excellent for temporal (ICC2,1 = 0.72–0.97) but only poor-to-fair for spatial-related gait parameters (ICC2,1 = 0.37–0.52). Conclusion: The smart walker–integrated gait analysis system has good concurrent validity with the GAITRite system for measuring temporal but not spatial-related gait parameters in potential end-users of the smart walker. Stride length and gait speed can be measured with good consistency, but with only limited absolute accuracy.

Exploring the Views of Individuals With Chronic Obstructive Pulmonary Disease on the Use of Rollators: A QUALITATIVE STUDY.

Although it has been well documented that the progressive exercise limitation associated with chronic obstructive pulmonary disease can be helped with an assistive device, such as a rollator, many individuals use it infrequently. This study seeks to explore the views of individuals with chronic obstructive pulmonary disease regarding the use of rollators. A qualitative study design was used. Twelve individuals with moderate to very severe chronic obstructive pulmonary disease were recruited from an outpatient pulmonary rehabilitation program to participate in semistructured interviews. Inductive thematic analysis was applied. Analysis revealed 5 themes: (1) "acquiring a rollator" reflecting the process of obtaining a device either via a health care professional or self-referral; (2) "acceptance versus resistance" describing opposing views regarding rollator usage; (3) "rollator roadblocks" describing practical barriers to use; (4) "participation" reflecting how rollators can promote reintegration into society; and (5) "revising perceptions" whereby participants embodied an eventual acceptance of rollators. Rollator acquisition appeared to be a unilateral, prescriptive process. Individuals described initial resistance to use, although in the long-term, negative perceptions were outweighed by the functional and social benefits of rollator use. Encouraging users to participate in deciding whether to use a rollator and providing adequate education on its indications, benefits, barriers, and facilitators are likely to promote optimal use of a rollator.

Development of a video-based technique for ambulatory monitoring of foot placement with an instrumented rollator.

To develop a video-based system, mounted on a rollator to quantify the step width values of rollator users in the community. A total of 5 able-bodied young adults, age range 24-28 years. A digital video camera system was mounted on the rollator frame to capture the position of the participant's feet during overground walking. A method of estimating step width from the video data was developed and evaluated against the output from a concurrently recording Vicon MX motion capture system. Mean step widths of the rollator and motion capture systems were 14.40 cm (standard deviation (SD) 4.64) and 14.37 cm (SD 4.34), respectively, revealing a strong level of agreement; intra-class correlation coefficient 0.999 (95% confidence interval (95% CI) 0.987-1.000; and root-mean-square difference 0.70 cm. The video-based system mounted on a rollator to collect foot placement data enabled accurate measurement of step width during rollator use. The ability to record foot placement measurements outside the laboratory setting, characterizing foot placement patterns occurring in the community, will enable research into how these assistive devices influence mobility during everyday use.

Upper Limb Contributions to Frontal Plane Balance Control in Rollator-Assisted Walking

While assisting with balance is a primary reason for rollator use, few studies have examined how the upper limbs are used for balance. This study examines upper limb contributions to balance control during rollator-assisted walking. We hypothesized that there would be an increased upper limb contribution, measured by mean vertical loading (Fz) and variation in frontal plane center-of-pressure (COPhigh), when walking balance is challenged/impaired. Experiment 1 compared straight-line and beam-walking in young adults (n = 11). As hypothesized, Fz and COPhighincreased in beam-walking compared to baseline (mean Fz: 13.7 vs. 9.1% body weight (BW), p < 0.001, RMS COPhigh: 1.35 vs. 1.07 cm, p < 0.001). Experiment 2 compared older adults who regularly use rollators (RU, n = 10) to older adult controls (CTL, n = 10). The predicted higher upper limb contribution in the RU group was not supported. However, when individuals were grouped by balance impairment, those with the lowest Berg Balance scores (< 45) demonstrated greater speed-adjusted COPhigh than those with higher scores (p = 0.013). Furthermore, greater COPhigh and Fz were correlated to greater reduction in step width, supporting the role of upper limb contributions to frontal plane balance. This work will guide studies assessing reliance on rollators by providing a basis for measurement of upper limb balance contributions.

Rollator Use Does Not Consistently Change the Metabolic Cost of Walking in People With Chronic Obstructive Pulmonary Disease

Hill K, Dolmage TE, Woon LJ, Brooks D, Goldstein RS. Rollator use does not consistently change the metabolic cost of walking in people with chronic obstructive pulmonary disease. ObjectivesTo (1) evaluate whether the use of a rollator changed metabolic cost during a controlled walking task, and (2) explore relationships between the difference in dyspnea and metabolic cost associated with rollator use. DesignSingle-group interventional study in which patients completed 2 corridor walks: 1 without and 1 with a rollator, at the same individualized constant speed. SettingRehabilitation hospital. ParticipantsPatients with chronic obstructive pulmonary disease (N=15; 10 men; median age [interquartile range; IQR]=69 [12]y; forced expiratory volume in 1 second=42 [20]% predicted). InterventionRollator use. Main Outcome MeasuresOxygen uptake, converted to metabolic equivalent units (METs), and minute ventilation were measured throughout both tasks using a portable gas analysis system; dyspnea and arterial oxygen saturation (SpO2) were collected on completion. ResultsMedian [IQR] walk speed [IQR] was 48 (10)m/min. Walking with a rollator, compared with walking without, reduced dyspnea (median [IQR]=1.0 [1.5] vs 2.0 [2.0]; P=.01) without changing energy expenditure (median [IQR]=2.8 [1.2] vs 3.2 [0.9] METs; P=.65), minute ventilation (median [IQR]=30.3 [9.6] vs 27.7 [9.9]L/min; P=.50), or SpO2 (median [IQR]=92 [8]% vs 94 [10]%; P=.41). The association between the reduction in dyspnea and any difference in energy expenditure related to rollator use was of borderline significance (rs=.50; P=.06). Six of the 8 participants who experienced a reduction in dyspnea also demonstrated a reduction in the metabolic cost of walking. ConclusionsThe mechanism responsible for the amelioration in dyspnea during rollator-assisted walking is multifactorial. A reduction in the metabolic cost of walking may play a part in some, but not all, patients.

Accuracy and responsiveness of the stepwatch activity monitor and ActivPAL in patients with COPD when walking with and without a rollator

Purpose: To evaluate the measurement properties of the StepWatch™ Activity Monitor (SAM) and ActivPAL in COPD. Method: Whilst wearing both monitors, participants performed walking tasks at two self-selected speeds, with and without a rollator. Steps obtained using the monitors were compared with that measured by direct observation. Results: Twenty participants aged 73 ± 9 years (FEV1 = 35 ± 13% pred; 8 males) completed the study. Average speeds for the slow and normal walking tasks were 34 ± 7 m·min−1and 46 ± 10 m·min−1, respectively. Agreement between steps recorded by the SAM with steps counted was similar irrespective of speed or rollator use (p = 0.63) with a mean difference and limit of agreement (LOA) of 2 steps·min−1 and 6 steps·min−1, respectively. Agreement for the ActivPAL was worse at slow speeds (mean difference 7 steps·min−1; LOA 10 steps·min−1) compared with normal speeds (mean difference 4 steps·min−1; LOA 5 steps·min−1) (p = 0.03), but was unaffected by rollator use. The change in step rate between slow and normal walking via direct observation was 12 ± 7 steps·min−1 which was similar to that detected by the SAM (12 ± 6 steps·min−1) and ActivPAL (14 ± 7 steps·min−1). Conclusions: The SAM can be used to detect steps in people who walk very slowly including those who use a rollator. Both devices were sensitive to small changes.Implications for RehabilitationThe evaluation of physical activity (PA) before and after pulmonary rehabilitation in people with chronic obstructive pulmonary disease (COPD) has evolved to be an important outcome measure.Selecting an appropriate device to obtain valid measures of PA remains a challenge, especially for those individuals who walk slowly or use a rollator to assist with ambulation.The StepWatchTM Activity Monitor and the ActivPAL have been shown in this study to be sensitive to small changes in step rate, thus these devices can be used to assess changes in physical activity in individuals with COPD such as following pulmonary rehabilitation, including those who walk slowly or use a walking aid such as a rollator.

Rollator use adversely impacts on assessment of gait and mobility during geriatric rehabilitation

To investigate the influence of the use of a rollator walking aid on assessment of gait and mobility. Prospective, longitudinal study. Geriatric patients during inpatient rehabilitation (n=109; mean age 83.1 years). Assessment at the beginning and prior to discharge from rehabilitation using: gait-analysis (GAITRite®, speed, cadence, stride-time, stride-length, base-of-support, double-support), Performance-Oriented-Mobility-Assessment (POMA), and Timed-Up-and-Go (TUG). Differences between outcomes obtained without and with rollator use were calculated for baseline assessment and for changes over time for the total group and subgroups according to diagnosis (hip fracture vs. other). Responsiveness was calculated using standardized response means. Baseline performances were significantly (p ≤ 0.05) higher when assessed with vs. without rollator in the total group and in hip fracture (except cadence) and other (except cadence, stride-time, TUG) patients. Changes over time were significantly greater when assessed without vs. with rollator in the total group and hip fracture (except cadence, POMA) and other patients (except base-of-support, double-support). Tests without rollator showed superior responsiveness (except TUG). The use of rollator walking aids limits the detection of initial gait and mobility deficits, adversely affects the assessment of changes over time in gait and mobility performance, and reduces the responsiveness of tests. When full weight-bearing is permitted, assessment without a walking aid is recommended.

Measurement properties of the SenseWear armband in adults with chronic obstructive pulmonary disease

RationaleThe SenseWear armband (SAB) is designed to measure energy expenditure (EE). In people with chronic obstructive pulmonary disease (COPD), EE estimated using the SAB (EESAB) is a popular outcome measure....

Rollator use and functional outcome of geriatric rehabilitation

In a quasi-experimental pre- and postdesign, we examined the effect of rollator use on functional rehabilitation outcome in geriatric patients.From a sample of 458 geriatric inpatients, we matched 30 subjects who were not using assistive devices in their everyday lives but received a wheeled walker at the time of hospital admission (first-time user group) according to their admission scores on three motor performance tests (Timed Up-and-Go, Five-Times-Sit-to-Stand, and Performance-Oriented Mobility Assessment -Balance) with 30 patients who were actively using rollators as their primary walking aid for at least 3 months (long-term user group) and 30 control subjects without walking-aid assistance. Measurements were repeated after the inpatient rehabilitation regimen.The Kruskal-Wallis test did not reveal significant group differences in rehabilitation progress. Controls and device users, regardless of walking-aid experience, demonstrated nearly comparable mobility, strength, and balance improvements. More than half of each cohort (controls, n = 22; first-time, n = 17; long-term, n = 18) achieved functional gains in all three motor tests.The study showed that rollator assistance does not interfere with rehabilitation outcome and, to some extent, legitimates the prescription of assistive devices to improve confidence and restore or maintain motor ability at the highest possible level.

Physical Performance In Geriatrics: Affected By Rollator Use?

Physical Performance In Geriatrics: Affected By Rollator Use?

Daily Utility and Satisfaction With Rollators Among Persons With Chronic Obstructive Pulmonary Disease

Hill K, Goldstein R, Gartner EJ, Brooks D. Daily utility and satisfaction with rollators among persons with chronic obstructive pulmonary disease. Objective To characterize the daily utility and satisfaction with rollators in patients with chronic obstructive pulmonary disease (COPD). Design Cross-sectional observational study. Setting Community. Participants COPD patients describing dyspnea during activities of living, who had been provided with a rollator by a health care professional within the preceding 5-year period. Interventions Not applicable. Main Outcome Measures Three questionnaires were administered in random order. The St. George's Respiratory Questionnaire was used to measure health-related quality of life, version 2.0 of the Quebec User Evaluation of Satisfaction with Assistive Technology was used to assess satisfaction with the rollator, and a structured questionnaire was used to obtain information regarding daily utility of the device and barriers to its use. Demographic data were obtained through patient interview. Anthropometric data, measurements of resting lung function, and 6-minute walk distance were extracted from the medical records. Results Twenty-seven (10 men) patients (forced expiratory volume in 1 second, 35.1%±22.3% predicted) completed the study. Sixteen (59%) patients reported daily rollator use. All patients used the rollator to assist with ambulation outdoors, but 16 (59%) patients stated that they did not use the rollator for any activity in their home. Although satisfaction with the rollator was high, women were less satisfied with the weight of the device than men ( P=.008). Thirteen (48%) patients reported being embarrassed while using the device. Conclusions COPD patients provided with a rollator for use during daily life were most satisfied with its effectiveness and least satisfied with its weight. Daily use was generally high with over half the patients using the rollator on a daily basis. Rollators were more often used outdoors than indoors.

Effects of a rollator use on exercise capacity in patients with chronic respiratory failure

Effects of a rollator use on exercise capacity in patients with chronic respiratory failure

Effect of Rollator Use on Health-Related Quality of Life in Individuals With COPD

The purpose of this study was to evaluate the influence of rollator use on health-related quality of life in patients with COPD. Randomized controlled trial. Thirty-one postrehabilitation patients with COPD were randomized to receive a rollator (n = 18) or usual care (n = 13) for 8 weeks and to record the frequency of rollator use. Outcome measures at baseline, 4 weeks, and 8 weeks included the Chronic Respiratory Questionnaire (CRQ) and the 6-min walk (6MW). During acute testing, subjects consistently walked further when assisted (baseline 6MW: 292 +/- 67 m vs 263 +/- 67 m; 8 weeks: 283 +/- 65 m vs 259 +/- 68 m [+/-SD]; p = 0.013). However, provision of a rollator at home was not associated with group differences in the CRQ (p > 0.08) or in the unassisted 6MW (p = 0.4) or the assisted 6MW (p = 0.5). Eight of 18 subjects assigned to the rollator group used the rollator less than three times per week. Regular users demonstrated a consistent improvement in mastery compared with infrequent users (4 weeks: 4.7 +/- 0.6 vs 5.2 +/- 0.8, respectively; 8 weeks: 5.3 +/- 0.8 vs 4.7 +/- 0.4; p = 0.014). Despite evidence of effectiveness during acute testing, this study did not demonstrate a rollator effect on quality of life or exercise capacity when the rollator was provided at home, for a longer period. Actual use of a rollator may be an important determinant of its effect. Therefore, when prescribing a rollator, health-care professionals should attempt to identify those most likely to use it.

The Acute Effects of a Rollator in Individuals With COPD

To investigate whether the acute benefits of rollator use are consistent over time in individuals with moderate to severe chronic obstructive pulmonary disease. Thirty-one stable subjects with chronic obstructive pulmonary disease (13 men, 18 women), aged 68 +/- 8 years, with a forced expiratory volume in 1 second of 0.7 +/- 0.2 L (33% +/- 12% predicted) and a baseline 6-minute walk (6MW) of 261 +/- 68 m, were recruited from a respiratory clinic after completion of a pulmonary rehabilitation program. Two 6MWs were performed at baseline, 4 weeks, and 8 weeks, one walking unaided and the other walking with the assistance of a rollator. The test order was randomly chosen at baseline, and the same test order was used at each time point. The primary outcome measures were distance walked in 6 minutes (meters), perceived dyspnea using a modified Borg scale, and number of rests taken. Subjects achieved higher 6MW distances during assisted compared with unassisted walking at baseline (292 +/- 67 vs 263 +/- 67 m), 4 weeks (296 +/- 62 vs 275 +/- 63m), and 8 weeks (283 +/- 65 vs 259 +/- 68 m) (P = .013), with no time effect (P = .5). In addition, use of a rollator resulted in a significant improvement in dyspnea (P = .004) at baseline, 4 weeks, and 8 weeks, with no time effect (P = .7). The use of a rollator also reduced the number of rests taken during the 6MW (P < .001), with no time effect (P = .9). Rollator use resulted in improvements in performance in the 6MW, which were consistent over time among individuals with moderate to severe chronic obstructive pulmonary disease who walk less than 375 m during an unaided 6MW.