Walking Aid Use in Canada: Prevalence and Demographic Characteristics Among Community-Dwelling Users

Simple Mobility Tests Predict Use of Assistive Devices in Older Adults

BACKGROUND

Assistive devices (ADs) for ambulation are commonly provided to improve safety and independence in older adults. Despite the common use of these devices, there are no standard prescribing guidelines, and non-health care providers, including caregivers and family members, often make decisions about the need for ADs. Identifying factors or a single screening test associated with AD use would benefit clinicians and non-health care caregivers in making decisions to adopt an AD for patients, clients, and family members.

PURPOSE/OBJECTIVES

The purpose of this cross-sectional study was to identify the test that best predicts ADs for ambulation and non-AD use among community-dwelling individuals.

METHODS

Eighty-five older adults (81.6 ± 8.2 years old) who underwent outpatient physical therapy participated in this study. They participated in a series of tests, including the Timed Up and Go, handgrip and quadriceps strength, the 30-second chair-rise test, the 5-m fast gait speed, the Functional Independence Measure, the locomotive syndrome tests (stand-up test, 2-step test [2ST], and the Locomo-5 Checklist), and numeric pain scales. Mann-Whitney U tests were used to identify differences between those who did and did not use an AD for ambulation. Logistic regression analyses were used to examine which test best predicted AD use.

RESULTS

80% of participants (n = 68) used an AD for ambulation. There were significant differences in all test variables between users and nonusers ( P = .033 to P < .001), except for quadriceps strength, age, and pain (all P > .05). Only the 2ST was a significant predictor of AD use, with a cutoff distance of the toe-to-toe stride shorter than 93% of body height (sensitivity: 72%, and specificity: 82%, P = .048).

DISCUSSION

Simple functional measures differed between those who did and did not use ADs for ambulation; however, only the 2ST predicted AD status. Individuals who cannot step 93% of their body height may be appropriate for an AD.

CONCLUSIONS

If comprehensive clinical evaluations are not available to make decisions about AD use, the 2ST can be used to make clinical recommendations for an AD for ambulation.

The acceptability and accessibility of magnetic walking aids when used in hospital: a randomised trial

PURPOSE

Poor walking aid compliance and accessibility can put the user at an increased risk of falls. We explored the acceptability and accessibility of magnetic walking aids (MWAs) compared to standard walking aids (SWAs) in inpatients following joint replacement.

METHODS AND MATERIALS

A non-blinded pilot randomised controlled trial was conducted. Inpatients following hip or knee replacement were randomly allocated to the MWA group (n = 20) or the SWA group (n = 20). Primary outcomes were the acceptability and accessibility of the MWA compared to the SWA during their inpatient stay, assessed through made-to-measure patient and staff questionnaires. The secondary outcome was the number of times the walking aid came to rest on the floor, measured using logbooks kept by participants.

RESULTS

The participants in the MWA group reported their aid was more easily accessible, and that they were more likely to use their aid in their room than participants in the SWA group. Participants in the MWA group dropped their aid less often, with a median of 0.3 walking aid drops per day in the MWA group and 1.1 drops per day in the SWA group (p = 0.002).

CONCLUSION

The results of this pilot randomised trial suggest MWAs may be an acceptable and inexpensive intervention for improving walking aid accessibility and adherence and reducing walking aid drops when compared to SWAs.

The usability of rollators as part of the human-centred quality of mobility devices: a systematic narrative literature review

Purpose: The aim of this literature review was to identify and summarize aspects of the usability of rollators from the currently available research literature. Further objectives were the exploration of rollator requirements and the search for possible disciplinary differences in the consideration or elaboration of usability aspects.

Materials and Methods: Following the PRISMA guidelines, the databases CINAHL, Pubmed and Academic Search Elite were examined in the period from April - May 2023. For the synthesis of the quantitative and qualitative data and the identification of prominent themes in this work, a theory driven thematic analysis approach was used.

Results: A total of 45 publications were included (25 quantitative, 14 mixed methods, 6 qualitative) from various disciplines, the majority belonging to physiotherapy 42%, followed by engineering 16% and health sciences 16%. Aspects of usability were extracted using a deductive code catalogue based on QUEST 2.0. The categories "easy to use" (28/126), "comfort" (20/126), and "safety" (14/126) were most frequently assigned. While "repairs & servicing" (5/126), "service delivery" (4/126), and "durability" (3/126) were coded least frequently.

Conclusion: So far, no specific publications on the usability of rollators has been published, which made it necessary to summarize individual usability aspects using a deductive code catalogue. The results obtained, therefore, do not allow any generalized statement about the usability of rollators. However, this initiates discussions about the usability of rollators that should be studied in the future in a participatory and user-centred manner and, placing satisfaction more in the focus of usability engineering and evaluation of rollators.

Low adoption of mobility device in later life: Insights from the lens of intersectionality

OBJECTIVES

To investigate the utilization of mobility device, whether age and gender-related use disparities exist, and whether falls can further explain use disparities over time among Chinese older adults in need of devices.

METHODS

Community-dwelling older adults who needed mobility devices and completed four waves of the China Health and Retirement Survey 2011-2018 were included (N = 1,302). A categorical variable was created to represent respondents' intersectionality of age (50-64, 65-74, and ≥75 years) and gender (men vs. women).

RESULTS

The baseline prevalence of device use was 18.2 % (n = 237). Overall, the device use increased over time. Intersectionality-wise, oldest-old women were 1.53 times more likely than youngest-old men to use devices over time. Respondents with falls were more likely to use devices over time.

CONCLUSIONS

Older adults with mobility impairment, especially the oldest-old women and those with falls, lag in mobility devices utilization, suggesting future tailored interventions to support these populations.

Walking aid training as a clinical competence in Canadian entry-to-practice professional academic programs

PURPOSE

Multiple healthcare professionals fit walking aids (WA) and train individuals on their use. The purpose of this investigation was to describe curricula on WA fitting and training in Canadian entry-to-practice professional programs.

MATERIALS AND METHODS

An online survey was administered to leads from all accredited programs (n = 199). Seventeen questions asked about the importance of WA education, instructional methods and time dedicated to WA fitting and skills training, and how the pandemic had affected WA curriculum delivery.

RESULTS

Responses were received from 97 programs. While most occupational therapy (OT, 8/15), physiatry (PM&R, 5/9), and physical therapy (PT, 12/19) trainees received more than 3 h of instruction on WA fitting, most nursing (29/40) and pharmacy (7/8) programs spent less than 3 h on this topic. Most OT (9/15) and PT (15/19) programs spent more than 3 h on WA skills training whereas most nursing (25/40), pharmacy (4/8), and PM&R (5/9) programs spent less than 3 h on this subject. Across all programs, 52% educated students on adapting activities of daily living for WA while 18% provided education on WA maintenance and repair. Only 19/89 programs consulted a formal WA skills training resource for curriculum development. Seventeen of 55 programs modified their WA curricula due to the pandemic.

CONCLUSIONS

There is a wide range in curricular approaches to WA education in Canadian professional programs. This highlights the need for a standardised WA education program to guide curricular development to ultimately improve safe WA use for clients with short- and long-term mobility impairments.IMPLICATIONS FOR REHABILITATIONCurricula on walking aids is extremely variable within and between programs.Navigating terrains, adapting activities of daily living, and maintenance are poorly taught.There is a need for a national standardized curriculum on walking aids.This curriculum should be modular and designed for practitioners, students, and patients.

Advances in mobility aid use reporting: situational context and objective measurement improve understanding of daily aid use in older adults

BACKGROUND

Understanding mobility aid use has implications for falls risk reduction and aid prescription. However, aid use in daily life is understudied and more complex than revealed by commonly used yes/no self-reporting.

AIMS

To advance approaches for evaluating mobility aid use among older adults using a situational (context-driven) questionnaire and wearable sensors.

METHODS

Data from two cross-sectional observational studies of older adults were used: (1) 190 participants (86 ± 5 years) completed tests of standing, sit-to-stand, walking, grip strength, and self-reported fear of falling and (2) 20 participants (90 ± 4 years) wore two body-worn and one aid-mounted sensors continuously for seven days to objectively quantify aid use during walking. Situational and traditional binary reporting stratified participants into aid dependency levels (0-4) and aid-user groups, respectively. Physical performance and fear of falling were compared between aid users, and dependency levels and sensor-derived walking behaviors were compared to reported aid use.

RESULTS

Physical performance and fear of falling differed between aid-user groups (P < 0.05). Sensor-derived outputs revealed differences in walking behaviors and aid use when categorized by dependency level and walking bout length (P < 0.05). Walking bout frequency (rho(18) = - 0.47, P = 0.038) and aid use time (rho(13) = .72, P = 0.002) were associated with dependency level.

DISCUSSION

Comparisons of situational aid dependency revealed heterogeneity between aid users suggesting binary aid use reporting fails to identify individual differences in walking and aid use behaviors.

CONCLUSIONS

Enhanced subjective aid use reporting and objective measurements of walking and aid use may improve aid prescription and inform intervention to support safe and effective mobility in older adults.

Validation of an Activity Type Recognition Model Classifying Daily Physical Behavior in Older Adults: The HAR70+ Model

Activity monitoring combined with machine learning (ML) methods can contribute to detailed knowledge about daily physical behavior in older adults. The current study (1) evaluated the performance of an existing activity type recognition ML model (HARTH), based on data from healthy young adults, for classifying daily physical behavior in fit-to-frail older adults, (2) compared the performance with a ML model (HAR70+) that included training data from older adults, and (3) evaluated the ML models on older adults with and without walking aids. Eighteen older adults aged 70-95 years who ranged widely in physical function, including usage of walking aids, were equipped with a chest-mounted camera and two accelerometers during a semi-structured free-living protocol. Labeled accelerometer data from video analysis was used as ground truth for the classification of walking, standing, sitting, and lying identified by the ML models. Overall accuracy was high for both the HARTH model (91%) and the HAR70+ model (94%). The performance was lower for those using walking aids in both models, however, the overall accuracy improved from 87% to 93% in the HAR70+ model. The validated HAR70+ model contributes to more accurate classification of daily physical behavior in older adults that is essential for future research.

The relationship between self-reported physical frailty and sensor-based physical activity measures in older adults - a multicentric cross-sectional study

BACKGROUND

The decline in everyday life physical activity reflects and contributes to the frailty syndrome. While especially self-reported frailty assessments have the advantage of reaching large groups at low costs, little is known about the relationship between the self-report and objective measured daily physical activity behavior. The main objective was to evaluate whether and to what extent a self-reported assessment of frailty is associated with daily physical activity patterns.

METHODS

Daily activity data were obtained from 88 elderly participants (mean 80.6 ± 9.1 years) over up to 21 days. Acceleration data were collected via smartwatch. According to the results of a self-report frailty questionnaire, participants were retrospectively split up into three groups, F (frail, n = 43), P (pre-frail, n = 33), and R (robust, n = 12). Gait- and activity-related measures were derived from the built-in step detector and acceleration sensor and comprised, i.a., standard deviation of 5-s-mean amplitude deviation (MADstd), median MAD (MADmedian), and the 95th percentile of cadence (STEP95). Parameters were fed into a PCA and component scores were used to derive behavioral clusters.

RESULTS

The PCA suggested two components, one describing gait and one upper limb activity. Mainly gait related parameters showed meaningful associations with the self-reported frailty score (STEP95: R² = 0.25), while measures of upper limb activity had lower coefficients (MADmedian: R² = 0.07). Cluster analysis revealed two clusters with low and relatively high activity in both dimensions (cluster 2 and 3). Interestingly, a third cluster (cluster 1) was characterized by high activity and low extent of ambulation. Comparisons between the clusters showed significant differences between activity, gait, age, sex, number of chronic diseases, health status, and walking aid. Particularly, cluster 1 contained a higher number of female participants, whose self-reports tended towards a low health status, the frequent use of a walking aid, and a higher score related to frailty questions.

CONCLUSIONS

The results demonstrate that subjective frailty assessments may be a simple first screening approach. However, especially older women using walking aids may classify themselves as frail despite still being active. Therefore, the results of self-reports may be particularly biased in older women.

Real-life experience of accepting assistive device services for Tibetans with dysfunction: A qualitative study

Objective

This study aimed to understand the real-life experiences of Tibetans in China with dysfunction in the process of accepting assistive device services and to provide a reference for service quality improvement and policy formulation.

Methods

Semi-structured personal interviews were used to collect data. Ten Tibetans with dysfunction representing three categories of different economic level areas in Lhasa, Tibet were selected to participate in the study by purposive sampling method from September to December 2021. The data were analyzed using Colaizzi's seven-step method.

Results

The results present three themes and seven sub-themes: identification of tangible benefits from assistive devices (enhancing self-care ability for persons with dysfunction, assisting family members with caregiving and promoting harmonious family relationships), problems and burdens (difficulty in accessing professional services and cumbersome processes, not knowing how to use it correctly, psychological burden: fear of falling and stigmatization), and needs and expectations (providing social support to reduce the cost of use, enhancing the accessibility of barrier-free facilities at the grassroots level and improving the environment for the use of assistive devices).

Conclusion

A proper understanding of the problems and challenges faced by Tibetans with dysfunction in the process of accepting assistive device services, focusing on the real-life experiences of people with functional impairment, and proposing targeted suggestions for improving and optimizing the user experience can provide reference and basis for future intervention studies and related policy formulation.

The effect of first-time 4-wheeled walker use on the gait of younger and older adults

INTRODUCTION

The 4-wheeled walker is intended to enhance balance and gait for older adults. Yet, some research suggests that walking aids increase falls risk. An understanding of the influence of age with walker use on gait performance is required.

OBJECTIVE

To examine the effect of initial 4-wheeled walker use on spatiotemporal gait parameters between younger and older adults.

DESIGN

Cross-sectional, repeated-measures.

SETTING

Community-dwelling.

PARTICIPANTS

Twenty-five younger (age: 26.5 ± 4.1 years) and 24 older (age: 68.5 ± 10.5 years) adults participated. Younger adults were aged 18 to 35 years, whereas older adults were 50 years or older. Included were people not requiring the use of a walking aid, and those able to converse in English.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURE(S)

Gait velocity and stride time variability were recorded using accelerometers. Gait was examined under three conditions: unassisted walking; walking with a 4-wheeled walker; and walking with a 4-wheeled walker while completing a secondary task. Conditions were performed across two walking paths: straight and figure-of-8 Walk Test. Separate mixed-methods analyses of variance (ANOVAs; within-subject: condition/path; between-subject: group) were used for statistical analyses.

RESULTS

Velocity was lower when walking using a walker while completing a cognitive task (p < .001), in the figure-of-8 Walk Test (p < .001), and in older adults (p = .001). Stride time variability increased with walking path and condition difficulty (p < .001) for the straight path versus the figure-of-8 Walk Test.

CONCLUSIONS

Using a 4-wheeled walker resulted in a slower and more inconsistent gait pattern across both age groups. Walking more complex configurations resulted in the prioritization of gait over the cognitive task while performing the dual-task conditions. No evidence of an age-related difference in the effect of initial walker use on gait was observed. Nonetheless, walkers are cognitively demanding and their introduction should warrant a clinical follow-up.

What contributes most to the SPPB and its subscores in hospitalized geriatric patients: an ICF model-based approach

Background

Mobility deficits are highly prevalent among geriatric patients and have serious impact on quality of life, hospitalizations, and mortality. This study aims to capture predictors of mobility deficits in hospitalized geriatric patients using the International Classification of Functioning, Disability and Health (ICF) model as a framework.

Methods

Data were obtained from n = 397 patients (78 ± 7 years, 15 ± 7 ICD-11 diagnoses) on a geriatric ward at time of admission. Mobility was assessed using the Short Physical Performance Battery (SPPB) total score and gait, static balance and transfer subscores. Parameters from an extensive assessment including medical history, neuropsychological and motor examination, and questionnaires were assigned to the five components of the ICF model. Spearman’s Correlation and multiple linear regression analyses were calculated to identify predictors for the SPPB total score and subscores.

Results

Use of walking aid, fear of falling (FOF, but not occurrence of previous falls), participation in society, ADL and grip strength were strongly associated with the SPPB total score and all subscores (p < .001). FOF and grip strength were significant predictors for the SPPB total score as well as for gait and transfer subscores. FOF also showed a strong association with the static balance subscore. The clinical parameters of the ICF model could only partially explain the variance in the SPPB total score (24%) and subscores (12–23%), with no parameter from the activities and participation component being significantly predictive.

Conclusions

FOF and reduced grip strength are associated with mobility deficits in a hospitalized geriatric cohort. Further research should focus on interventions to reduce FOF and increase muscle strength in geriatric patients. Moreover, there is a need for ICF-based assessments instruments (especially in the activities and participation components) that allow a holistic view on mobility and further daily life-relevant health aspects in geriatric patients.

Effects of using assistive devices on the components of the modified instrumented timed up and go test in healthy subjects

Introduction

Evaluation of the changes in gait spatiotemporal parameters and functional mobility with using assistive devices (ADs) would provide useful information and mutual assistance when prescribing such ambulatory devices. This study aimed to investigate the spatiotemporal gait and functional mobility parameters in healthy adults when walking using different ADs.

Methods

A group of healthy subjects participated in the study. The instrumented modified Timed Up and Go test (iTUG) was used to investigate the impact of different types of ADs on spatiotemporal and functional mobility parameters.

Results

Subjects showed a significant difference in the gait task performance (P = .001) in stride velocity, stride length, and cadence when walking with and without ADs. A significant difference was also found in the performance of the turn-to-sit task (P = .001) in both velocity and duration when walking with and without ADs. The time to complete sit-to-stand was significantly slower when using a walker (98.3 ± 22.3°/sec, P = .004) and a cane (78.2 ± 21.9°/sec, P = .004) compared to walking without an AD (78.2 ± 21.8°/sec). No significant difference was found between walking with a cane group versus walking with a four-wheeled walker group (P = .94).

Conclusion

ADs altered gait and functional mobility parameters differently in healthy subjects. Using a four-wheeled walker showed a tendency to increase stride velocity, cadence, stride length, and slow sit-to-stand velocity compared to using a cane. The findings highlight using more caution clinically when prescribing ADs and providing gait training.

Technical quality of online resources for mobility device training

Purpose: Training is recommended to improve safe and effective use of mobility aids. The internet offers a large amount of information and it can be difficult to identify resources with good quality. This project aimed to create a catalogue of online educational resources for mobility device training. The objective of this study was to identify and assess the quality of existing online educational resources for mobility device training for individuals with physical disabilities and caregivers.Methods: A Google search was conducted in October 2016 and replicated in January 2018. Resources were included if they were educational, were available in English or French, provided instruction or training in mobility aid use, were free of charge, and were targeted towards mobility device users or their caregivers. Resources were assessed using a modified version of the Journal of the American Medical Association (JAMA) benchmarks for the evaluation of technical quality.Results: Two hundred and seventy-one resources were included in the final analysis. Two resources were added by the research team for a total of 273 resources. The average JAMA quality score per mobility device varied between 3 (for crutches) and 5 (for knee scooters) out of 6, and weighted average was 3.6. The two resources added by the research team obtained a JAMA quality score of 6. 58 resources were retained for the catalogue.Conclusions: The results suggest that the technical quality of online educational resources for mobility device training could be improved. A need for higher quality resources for device users and caregivers was identified.Implications for rehabilitationThe overall technical quality of online educational resources for mobility device training for users and caregivers is low.A Mobility Device Training Catalogue is freely available and summarizes the highest quality online resources found on mobility device training.The Mobility Device Training Catalogue is intended for use by users and caregivers, but it may also provide clinicians with a tool that may be shared with their clients.

Assistive technology use and unmet need in Canada

BACKGROUND

Around the world, variations and inequities in access to assistive technology (AT) are evident. Development of legislation, policies, and programmes has not kept pace with the increasing demand for AT. Therefore, context-specific needs assessment is required, which can assist in anticipating the accessibility and human support needs of individuals with impairments, and in turn, inform resource allocation and prioritisation of services. The purpose of this cross-sectional study was to describe the current use and unmet needs of AT use in community-dwelling Canadians experiencing activity limitation or participation restriction (disability).

DATA AND METHODS

Bootstrapping was used to estimate the prevalence of AT use and unmet needs using data from the 2012 Canadian Survey on Disability (CSD). The total sample size for the CSD was 45,443 individuals.

RESULTS

Among the estimated 3,775,920 Canadians with a disability (13.7% of the Canadian population), 3,579,580 used some form of AT. Among these individuals, 3,050,750 use glasses or contact lenses and 1,109,060 use bathroom aids. The results of the study showed that the most common unmet need was for hearing aids (0.86% of the total population), followed by bathroom aids (0.36%).

INTERPRETATIONS

This study comes at a time when global attention is focussed on research on access to AT. This study using data from the CSD will serve disability and social policy analysts at all levels of government, as well as associations for persons with disabilities and researchers working in the field of disability policy and programmes.Implication for RehabilitationThe current initiatives on assistive technology, including the World Health Organization's Global Cooperation on Assistive Technology (GATE) project, recognize the substantial gap between the need for and provision of assistive devices. In Canada, for example, as well as in other countries, despite rapid growth in innovation, unmet needs for assistive devices persist and multiple barriers have been reported by individuals in accessing needed assistive devices. A better understanding of the met and unmet needs of assistive technology users can assist in anticipating accessibility and human support needs of individuals with disabilities, and in turn, inform resource allocation and prioritization of services. • The study estimates the prevalence of assistive device use in community dwelling Canadians and describes the unmet needs for assistive devices of Canadians with activity limitation (disability).• This study provides evidence on the use and unmet assistive technology needs for disability and social policy analysts at all levels of government, as well as associations for persons with disabilities and researchers working in the field of disability policy and programmes.• The results of this study can be used for planning and evaluating services, programmes and policies for Canadian adults with disabilities to help enable their full participation in society.

The association between cognition and gait in a representative sample of very old people - the influence of dementia and walking aid use

Background

Cognition has been related with gait speed in older adults; however, studies involving the oldest age group, where many have mobility disability and cognitive impairment, are few. The aim was to investigate the association between global cognitive function and gait speed in a representative sample of very old people, and whether the association was affected by dementia, and walking aid use.

Method

This cross-sectional study included 1317 participants, mean age 89.4 years, and 68% women, from the Umeå85+/Gerontological Regional Database. Self-paced gait speed was measured over 2.4 m, with or without walking aids, and global cognitive function with the Mini-Mental State Examination (MMSE). The association between cognition and gait speed was analyzed using multiple linear regression and stratified according to dementia. The influence of missing gait speed values was explored using multiple imputation. An interaction analysis was performed to investigate the influence of walking aid use.

Results

In comprehensively adjusted analyses, MMSE associated with gait speed (unstandardized β (β) 0.011 m/s, 95% Confidence Interval [CI] = 0.009, 0.013, p < 0.001) in the total sample. No association was found in people with dementia (β 0.003 m/s, 95%CI = 0.000, 0.006, p = 0.058), until missing gait speed values were compensated for by multiple imputation (β 0.007 m/s, 95% [CI] = 0.002, 0.011, p = 0.002). In interaction analysis the use of walking aids attenuated the association between cognition and gait speed (β − 0.019 m/s, 95%CI = − 0.024, − 0.013, p < 0.001).

Conclusion

Global cognitive function appears to associate with gait speed in very old people. However, in people with dementia selection bias was indicated since unless missing gait speed values were accounted for no association was observed. Walking aid use attenuated cognitive load, which may not apply to walking in daily activities, and requires further investigation.

The walking cane length influences the postural sway of community-dwelling older women

BACKGROUND

Mobility-related problems in older people may be relieved by the use of walking canes. However, the influence of the cane length on the postural stability of cane users has not been explored.

OBJECTIVE

The objective of this study is to examine the influence of a single-point cane with different lengths on the postural sway of regular cane users, older women during two stance positions, with feet parallel and semi-tandem stance.

METHODS

Eighteen older women, who used a single-point walking cane for at least 6 months, stood on a force plate with feet parallel or in semitandem position for 40 s. They always used a cane that was adjusted to one of three different lengths resulting from the distance between the wrist crease and the floor, named WF, or this distance plus 7.5 or 10 cm. Amplitude and speed of the centre of pressure (COP) and its components (rambling and trembling) in the anterior-posterior and medial-lateral directions and mean vertical force applied to the cane were compared across cane lengths.

RESULTS

The amplitude and velocity of COP, rambling and trembling increased with the cane length. This effect was observed for the anterior-posterior with the feet parallel and in the medial-lateral direction with the semi-tandem position. More force was applied on the shorter cane (WF) in semitandem position.

CONCLUSION

Longer canes increased the postural sway in the older women and restricted the body weight loaded on the cane. Improper cane length influences the postural sway particularly in a semitandem stance of regular cane users. This may cause a negative impact on postural stability required in daily life activities. The current findings may contribute to the prescription of this assistive device for older adults.

Mobility and Participation of People With Disabilities Using Mobility Assistive Technologies: Protocol for a Mixed-Methods Study

Background

Many community-dwelling individuals living with a disability use mobility assistive technologies (MATs). MAT devices are generally beneficial for individuals with mobility impairments. However, less is known about the specific factors that may foster or deter mobility and community participation.

Objective

The purpose of this protocol is to describe the methodology for a study including three main objectives: (1) to understand the places people using MAT go and the things they do, (2) to identify perceived barriers and facilitators as well as users’ desired environmental modifications, and (3) to understand subjective and objective issues related to environmental accessibility.

Methods

A mixed-methods study was conducted in Vancouver and in Quebec City. Qualitative interviews were conducted to address all three objectives. In addition, Objective 1 was achieved through collection of global positioning system (GPS) data and activity diaries with 36 participants per site who represented six types of MAT users (ie, cane, walker, crutches, manual wheelchair, power wheelchair, and scooter). All participants were invited to take part in all aspects of data collection. PhotoVoice was used to address Objectives 2 and 3. Two environmental audits were used to address Objective 2. The Stakeholders’ Walkability/Wheelability Audit in Neighbourhood (SWAN) measured perceptions related to a variety of community environmental features associated with mobility and participation. A total of 24 participants were recruited to each study site for SWAN data collection. The Measure of Environmental Accessibility (MEA) was also used to objectively measure access to exterior and interior environments selected earlier in the project by the participants that could benefit from improvements.

Results

Funding for this study was obtained from the Social Sciences and Humanities Research Council of Canada. Approval was obtained from the University of British Columbia Research Ethics Board and the Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale Research Ethics Board. Regarding the MEA evaluations, 19 locations (ie, buildings and exterior spaces) where obstacles have been identified by the participants of the PhotoVoice focus groups have been evaluated in Quebec City and 20 locations have been identified in the Vancouver region by the participants of the community forums. Data collection for this project was completed in December 2018. Analysis and writing of manuscripts are underway.

Conclusions

The use of a variety of methods to gather data on participation and mobility will allow a more holistic consideration of factors influencing mobility with a MAT device. This study will provide objective information about the mobility of participants and identify barriers and facilitators that impact their mobility and community participation. Through the mixed-methods approach employed in this study, we will gain a subjective evaluation of the participants’ neighborhoods, including personally meaningful information on environmental features that influence participants' everyday mobility and participation. We will also gain an objective evaluation of particular obstacles that community users of MAT identify as significant barriers to their ability to access public environments. We anticipate that these findings will help to identify a broad spectrum of solutions to improve the mobility and community participation of MAT users.

International Registered Report Identifier (IRRID)

DERR1-10.2196/12089