Training and provision of walking assistive devices improve autonomy, mobility, and reduce falls in older patients in emergency care

Renato Fraga Righetti, Pedro Kallas Curiati, Fernanda Sato Polesel, Wellington Pereira Yamaguti, Sâmia Denadai
Purpose:

Evaluate the efficacy of a training program and the provision of walking assistive devices regarding mobility, functionality, quality of life, fear of falling, depression, cognition, and fall occurrence within 90 days in older patients attending geriatric emergency care.


Methods:

A randomized, double-blind clinical trial was conducted with elderly patients (≥ 65 years) attending the Emergency Care (PA) at the Syrian-Lebanese Hospital (HSL) who met at least one criterion for the provision of walking assistive devices (WAD) according to institutional protocol. Patients with altered levels of consciousness, oxygen requirements of ≥3 L/min, respiratory discomfort, hemodynamic and/or postural instability, cognitive impairment, hospitalization after evaluation in the PA, and/or delirium were excluded. The participants were randomized into two groups: A) walking waid group (WA), which received training with a walking waid device and guidance on safe walking; B) the control group (CG), which received only guidance on safe walking. The collected variables included: sociodemographic and clinical data; medications; mobility in living spaces; gait speed; muscle strength; functionality; quality of life; fear of falling; cognition; depression; occurrence of falls; clinical severity; geriatric vulnerability; and frailty. Assessment moments were baseline, post-intervention, and 90 days after the emergency care visit. Statistical analysis was performed using paired T-tests, Wilcoxon tests, unpaired T-tests, Mann-Whitney tests, Kruskal-Wallis tests, and Fisher's exact test, according to the normality established by the Shapiro-Wilk test. The significance level was set at 5%.

Results:

The study included 44 participants. The walking assistive device group (WA) showed better indices of mobility, functionality, fear of falling, and cognition 90 days after the emergency care visit when compared to both their baseline performance and the performance of the control group (CG) during the same follow-up period (p0.05). Quality of life and depression improved in the WA group after 90 days compared to baseline (p0.05) but without a significant difference compared to the GC. The occurrence of falls was not associated with the provision of walking assistive devices.

Conclusion(s):

The training and provision of walking assistive devices were associated with improvements in mobility, functionality, quality of life, fear of falling, depression, and cognition within 90 days.

Implications:

A protocol for assessment and training with the use of walking assistive devices in geriatric emergency care was able to identify the mobility needs of older patients and provide an intervention to improve their mobility within their living spaces


Funding acknowledgements:
Research Call for Proposals from the Faculdade Sírio-Libanês, São Paulo - Brazil
Keywords:
older patients
walking assistive device
geriatric emergency care
Primary topic:
Older people
Did this work require ethics approval?:
Yes
Name the institution and ethics committee that approved your work:
Hospital Sírio-Libanês Research Ethics Committee and the protocol design wasregistered in the Clinical Trials database.
Provide the ethics approval number:
Ethics Number 6,430,440 and NCT05950269
Has any of this material been/due to be published or presented at another national or international conference prior to the World Physiotherapy Congress 2025?:
Yes

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