Walking on the edge: meanings of living in an ageing body and using a walker in everyday life - a phenomenological hermeneutic study

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.

Stigma and the use of umbrellas, hiking poles and walking sticks to aid walking in Hong Kong

Background

The use of walking aids is widely acknowledged as one of the most relied-on forms of assistive technology. Using stick-shaped devices, such as a cane, is often the entrance for many people to the world of assistive technologies, often accompanied by the negative stigma associated with ageing and disability.

Objectives

This study investigated the perception of disability and needs of the Hong Kong population using walking aids, aiming to inform device design and service provision.

Methods

We observed 391 individuals using cane-like devices in their natural environment and conducted semi-structured interviews with 28 participants to understand stigma, barriers to acquisition, training, and design requirements.

Results

Half of the interviewees (50%, n = 14) did not feel disabled when using a walking stick, while 39% felt slightly disabled. 56% of the observed sample used non-medical-looking aids like hiking poles or umbrellas. Most interviewees (79%) purchased off-the-shelf devices, but less than half received seller support in choosing appropriate aids.

Conclusion

The feelings associated with using walking sticks and similar devices are mostly positive. There is a preference in Hong Kong for using devices without a medical appearance to aid walking, such as umbrellas and hiking poles. There is a need to raise awareness of the risks of using umbrellas to aid walking and empower the user to make informed decisions when purchasing walking aid devices. In addition, there is a need to support the supply chain of walking aids, including umbrellas and hiking poles, to provide more information on device use, misuse, training, and maintenance.

User perspectives on the future of mobility assistive devices: Understanding users’ assistive device experiences and needs

Introduction

Current assistive devices are inadequate in addressing the needs of some people living with impaired mobility. This study explored the experiences of living with impaired mobility in relation to how wearable assistive adaptive and rehabilitative technologies may improve their quality of life.

Methods

A cross-case study approach was adopted; the case being defined as the experience of impaired mobility. Semi-structured interviews were utilised. The sample ( n = 8) was purposefully selected to have impaired mobility due to stroke, age-related frailty, or lower limb amputation. From the interview transcripts, in-depth case illustrations were written to provide personal stories and thematic analysis was carried out to provide a cross-case analysis.

Results

There were two overarching themes: lifestyle changes; and wishes and desires for assistive devices. There were shared experiences across participant groups, such as falls and fear of falling. All participants identified a wish for increased speed of walking. However, the reasons for their difficulties differed depending on personal factors and their condition. Participants wanted devices to be adjustable to their perceived ability on a day-to-day basis.

Conclusions

Although common concerns and impacts of living with impaired mobility were apparent, individuals have unique requirements that should inform the design of assistive technology devices.

The impact of walker height positions and their influence on triceps activity and energy conservation: a pilot study

Background/Aims

Millions of adults use walkers for functional mobility. Inappropriate walker use is associated with incorrect height, forward-leaning posture, and increased energy expenditure. Few studies have investigated the impact of walker positions and their influence on triceps activity. The present study assessed walker height and baseline positioning for individuals with a 50% weight bearing restriction of the lower extremity, and implications for energy conservation.

Methods

A total of 38 young adults (mean age = 24.95 years; 84.2% female; 15.8% male) participated in this study with a two-wheeled walker. Participants executed five walker positions while maintaining 50% weight bearing of the lower extremity to determine the effect on triceps electromyography activity.

Results

Triceps electromyography activity did significantly change across the five walker positions assessed (X2 [df=37, P<0.001]). This study showed that the median electromyography activity for positions B (median=0.268) and A (median=0.280) was significantly less than the median electromyography activity for position E (median=0.452; P<0.001). The effect sizes for comparisons of positions B and E (r=0.49) as well as A and E were the largest (r=0.53).

Conclusions

These findings suggest an elbow angle of 26–35° (position B), followed by an elbow angle of 15–25° (position A), with the walker in line with the heels of the participant, to be superior in minimising exertion of the triceps.

The experience and meaning of aging with multiple sclerosis: An existential phenomenological approach

OBJECTIVES

Over the past 3 decades there have been significant advances in the development of pharmaceutical and rehabilitative treatments for persons with multiple sclerosis (MS), such that life expectancy is continuing to increase. Whilst these advancements are exciting, there are also concerns and unknowns regarding what it is like to age with MS. The objectives of this research were to explore the lived experiences and meaning of aging in conjunction with having MS.

METHODS

Semi-structured interviews with 40 persons with MS over 60 years were conducted. Thereafter data were subject to an existential phenomenological analysis.

RESULTS

Four different ways were discussed with regards to embodied experiences of aging with MS: aging makes MS worse; MS makes aging worse; aging makes MS better; and MS makes aging better.

DISCUSSION

This research highlighted the complexity of aging with MS and the various of ways persons over 60 with MS experience and interpret this phenomenon.

"I have no reason not to be happy": The social and bodily conditions of positive aging for Latin-American men in Mexico

CONTEXT

Latin-American countries are faced with the challenge of trying to adapt to an aging population, which is exacerbated by the unequal access to income through social security. Previous research from Mexico has focused on the negative consequences of aging in contexts of social adversity.

OBJECTIVES

To explore, describe, and characterize the lived experience of old age in Mexican retired men who, despite having diverse medical conditions and meager funds in retirement, led independent and fairly fulfilling lives.

METHODS

An in-depth idiographic analysis was conducted following the experiential methodology of Interpretive Phenomenological Analysis (IPA). Ten participants (aged 65-81) were interviewed.

RESULTS

Two superordinate themes emerged as the subjective conditions for a positive experience in old age: (1) the conservation of social agency, and (2) the preservation of a strong bodily identity. Participants from different occupations prior to retirement depicted contrasting narratives.

CONCLUSIONS

Perceived financial security, despite modest means, was the underlying condition upon which subjective experiences of old age was based. The results show that in countries like Mexico, there is a possibility to reimagine old age as a fulfilling stage in life.

Psychosocial impact of mobility assistive technology on people with neurological conditions

INTRODUCTION

A wide range of products are available to assist mobility, and it is, therefore, of great importance to obtain empirical information regarding the expected impact of the use of these products based on outcome measures. People affected by neurological disorders often use products to assist mobility such as wheelchairs (both manual self-propelled wheelchairs and externally propelled chairs such as electric wheelchairs), walkers, walking sticks, etc. It is important to conduct an assessment of the psychosocial impact of these products on the lives of affected people.

METHODS

We performed this assessment using the Psychosocial Impact of Assistive Devices Scale (PIADS) and a socio-demographic questionnaire.

RESULTS

The results showed greater psychosocial benefits relating to the use of electric wheelchairs in comparison with walking sticks or manual, non-self-propelled chairs. Moreover, significant differences are present in the three subscales of the PIADS in relation to variables such as age, training in the use of assistive technology (AT) and funding.

CONCLUSION

Therefore, we conclude that the use of AT should be promoted among this group as a way to improve their adaptability, competency and self-esteem, and to reduce limits on participation deriving from the physical and contextual barriers faced by this collective.Implications for rehabilitationAmong the assessment of different mobility AT displaying a higher score in the three subscales of the PIADS amongst people using electric wheelchairs than among those using non-self-propelled manual wheelchairs. On the other hand, we found that the walker has a significant score only in the competence subscale. Canes, for example the stick 4-p is significant in the three subscales, or the walking cane in terms of competence. Despite the fact that crutches and walking sticks obtained the lowest score in this study.Not only the assessment is necessary, but also the adjustment of AT to the person who is going to use it, as well as some training on how to use it. Only 23.8% of the participants received training in the use of their main assistive device in this study.The results seem to indicate that for elder users, the score on adaptability with the AT is lower. That may result in future lines of research in usability and improving in terms of the needs of end-users and these AT since a high percentage of people with neurological conditions are elder people.The application of specific scales such as PIADS that helps to measure the use and capacity of the AT prescribed to patients with neurological disease provides more informed clinical reasoning.

High on Walking: Conquering Everyday Life

The aim of this study is to discuss the meaning of walking impairment among people who have previously been able to walk on their own. The study is based on findings from three different life situations: older people recovering after admission in intermediate care, people who have lost a leg, and people who live with Parkinson's disease. The analysis of the data is inspired by Paul Ricoeur's philosophy of interpretation. Four themes were identified: (a) I feel high in two ways; (b) Walking has to be automatic; (c) Every Monday, I walk with the girls in the park; and (d) I dream of walking along the street without sticks and things like that. The findings demonstrate that inability to walk profoundly affected the participants' lives. Other problems seemed small by comparison because walking impairment was at the same time experienced as a concrete physical limit and an existential deficit.

Leisure activities and mobility device use among very old people in Latvia and in Sweden

Introduction

Opportunities for leisure activities and physical mobility are important for the ageing population. Therefore, we aim to describe leisure activities outside the home among very old (over 80 years of age) users and non-users of mobility devices in two European countries.

Method

Survey data on mobility device use, self-rated physical mobility and leisure activities outside the home were utilised for a Latvian ( n = 225) and Swedish ( n = 314) sample. Differences in type and number of leisure activities were studied between the countries and for four groups of participants according to use/non-use of and level of physical mobility.

Results

Significant differences in type and number of leisure activities were seen between the national samples and among the participant groups. In general, each participant group in the Swedish sample reported more leisure activities than did those in the Latvian sample. Non-users with good physical mobility reported significantly more leisure activities than all other participant groups.

Conclusion

There are differences between the two national contexts in the type and number of leisure activities reported. To support very old people’s participation in outdoor leisure activities, we need more knowledge as to how physical, institutional and sociocultural environments affect very old people’s opportunities to engage in and perform such activities.