The Impact of Age and Physical Assessment Measures on Performance Among Non-Weightbearing Walking Aids: A Randomized Clinical Trial

Background: Walking aids for non-weightbearing (NWB) ambulation are often arbitrarily provided with no evidence that physical assessment predicts ambulatory performance. Purpose: We sought to determine if convenient physical assessment measures could guide NWB walking aid prescription and to determine how age impacts ambulatory performance. Methods: This prospective randomized crossover study examined 22 healthy adults, recruited from Saskatoon, Saskatchewan, and surrounding area through flyers and word of mouth. Inclusion criteria were independent unrestricted community dwellers with no self-reported neuromusculoskeletal or cardiovascular conditions who were age 18 years or older. Participants were stratified into 2 age cohorts: younger (age <50 years) and older (age ≥50 years). Physical assessment measures included triceps and latissimus dorsi strength, single lower-limb balance, and arm endurance. Performance measures included distance traversed, rate of perceived exertion, and peak stance limb plantar force (SLPF) evaluated among 4 walking conditions: unaided, NWB with crutches, standard walker, and wheeled knee walker. Two analyses were performed, one using the entire sample population and another split by age. Results: There were no differences in physical assessment measures between the younger and older cohort, yet distance traversed in the older cohort was highly dependent on all physical assessment measures when using crutches or a standard walker. Peak SLPF was reduced in the younger cohort when using the wheeled knee walker, but not in the older cohort. In the younger participants, reducing peak SLPF was highly dependent on arm endurance when using a standard walker or crutches and latissimus dorsi strength when using the wheeled knee walker. Surprisingly, older participants with stronger latissimus dorsi strength reported a higher rate of perceived exertion when using the wheeled knee walker compared to other devices. Conclusion: Arm strength, single lower-limb balance, and arm endurance should be considered when prescribing walking aids in older adults, and the wheeled knee walker should be considered in younger adults in need of reduced peak SLPF. Level of Evidence: Level III, prospective randomized comparative study.