European Journal of Cardiovascular Medicine

Wearable AART (Adaptive Assistive Rehabilitation Technologies) provides an innovative solution for better quality of life in subjects with impairment associated with the mobility. It has been reported that nearly 14 million subjects from United Kingdom have mobility impairment with disability following 2018/2019 data with approximately 50% experiencing issues related with the mobility. Strokes and musculoskeletal disorders are the major causes of mobility associated disabilities, especially in elderly subjects.¹

Despite of various advantages and benefits of mobility assistive devices, various challenges have been encountered with their use reporting that subjects using four-wheel walker have various difficulties in navigation of public transports and doors along with limited freehand mobility with the use of walking sticks. Also, walkers with no storage baskets limit users from taking along the vital and essential items. In few subjects, these devices can lead to hazardous walking behavior.²

Following the data by WHO (World Health Organization) in 2022, it has been reported that approximately one-third of the global population need Aps or assistive products and due to disease prevalence and ageing, it is expected to increase by 3.5 billion by 2050. Subjects with disabilities presents the most vulnerable population needing assistive technology.³

Previous literature studies have reported that subjects having disabilities can result in economic loss up to 7% of the GDP (Gross Domestic Product) which highlights the vital role of investment in assistive devices.⁴ Hence, the present study was aimed to assess the preferences and concerns of walker users concerning wearable adaptive assistive rehabilitation. The study also assessed the involvement of the caregiver to offer improvement in support systems and device design

The present cross-sectional clinical study was aimed to assess the preferences and concerns of walker users concerning wearable adaptive assistive rehabilitation. The study also assessed the involvement of the caregiver to offer improvement in support systems and device design. Verbal and written informed consent were taken from all the subjects before study participation.

The study assessed 200 subjects that were using walkers for mobility related disabilities. The inclusion criteria for the study were subjects using walker for minimum three months, aged 20 years or more, and subjects from both the genders willing to participate in the study. The exclusion criteria for the study were subjects that did not sign the consent, subjects with neurological disorders affecting communication, and subjects aged <20 years.

All included participants were subjected to an interview which was a modified version of ADUEQ (Assistive Device User Experience Questionnaire). This standardized questionnaire has wide acceptability globally to assess, overall walker’s usability, physical discomfort, mobility constraints, and user satisfaction.

The structured questionnaire used to gather data in study subjects included three sections as sociodemographic and personal parameters having categorical questions to assess income level, employment, education, gender, and age of the subjects. Second section assessed walker-related experience as duration of using the walker, challenges faced, distance covered, and daily usage times. The third section assessed the walker usability and musculoskeletal symptoms including the functional dependence, comfort level, and physical strain which helped in overall impact and usability of the walker on well-being and mobility by the users.\

For anthropometric data, standard procedure was used to assess physical characteristics as weight in kg and height in cm using digital weighing scale and stadiometer respectively. BMI (body mass index) was then calculated and classified using WHO criteria as follows: underweight, normal, overweight, and obese subjects were assessed for BMI of < 18.5 kg/m², 18.5-22.9kg/m², ≥23 kg/m², and ≥30 kg/m².

The gathered data were statistically analyzed using the chi-square test, Fisher’s exact test, Mann Whitney U test, and SPSS (Statistical Package for the Social Sciences) software version 24.0 (IBM Corp., Armonk. NY, USA) using ANOVA, chi-square test, and student's t-test. The significance level was considered at a p-value of <0.05.

The present cross-sectional clinical study was aimed to assess the preferences and concerns of walker users concerning wearable adaptive assistive rehabilitation. The study also assessed the involvement of the caregiver to offer improvement in support systems and device design. The present study assessed 200 subjects that were using walkers or Adaptive Assistive Rehabilitation Technologies. In all the subjects, questionnaire was used to collect the data concerning their concerns, preferences, and approach of caregivers. There were 79% (n=158) male and 21% (n=42) females in the study. Majority of subjects were 20 years old and aged >40 years. Majority of the subjects had weight of >60 years with 52% (n=104) subjects. Most of the subjects were graduate, married and intermediate. Majority of subjects were professional with 55% (n=110) subjects with 43% (n=86) subjects being employed. Majority of subjects had income of 40,000-50,000 monthly (Table 1).

Table 1: Sociodemographic data in study subjects

The study results showed that for factors affecting walker use in study subjects, most common reason for using walker was temporary after surgery/fracture, most of subjects were disabled for 0-2 years with 77% (n=154) subjects, was used for 0-3 hours by 41% (n=82) subjects, and majority subjects covered distance of 100-500 m in a day as reported by 52% (n=104) subjects. Most common effect of long-term walker use was mobility detention reported by 75% (n=150) subjects, most common difficulty on not using walker was dependence reported by 65% (n=130) subjects. Most common reason for walker prescription was Rehabilitation following hospitalization/stroke as reported by 64% (n=128) subjects. Most commonly used walker was standard followed by folding. Most comfortable material was aluminium as reported by 49% (n=98) subjects followed by cast iron used by 40% (n=80) subjects. Factors that governed walker choice were easy transport and storage followed by independent activity performance, weight, no strain to wrist, durable body, sweat resistant grip, and adjustable height. Problems encountered on not using walker were slow and tiring to pick and settle and problems in learning balance reported by 100% (n=200) subjects and inability to carry things reported by 65% (n=130) subjects (Table 2).

Table 2: Factors affecting walker use in study subjects

It was seen that for experience for walker use at different places, confidence to use assistive ambulatory devices at various locations, 69% (n=138) subjects reported that their friends and family accept in same way, 100% (n=200) reported that they experience a better quality of life and feel that their life is normal, 46% (n=92) subjects reported risk of injuring oneself, and 32% (n=64) subjects reported no difficulty in acceptance of using the device. Concerning the experience of dependence on assistive devices, all 100% (n=200) subjects reported they are dependent for going to living area and bedroom. 68% (n=136) reported needing assisting devices outside the building, and 23% (n=46) reported needing them for shopping complexes (Table 3). For association in difficulties used faced with walker use and reason for using the device, significant results were highest for tendency to fall followed by unable to participate in community, dependence for work, unable to walk around and participate in community with p=0.0001 (Table 4).

Table 3: Experience for walker use at different places

Table 4: Association in difficulties used faced with walker use and reason for using the device

It was also seen that on assessing the significant factors influencing the selection of the walker, most significant factors were ease of use, durability, safety, effectiveness, weight, and dimension as reported by 31% (n=62) subjects followed by comfort reported by 25% (n=50) subjects, and adjustments as reported by 10% (n=10) subjects respectively (Table 5). Concerning the relationship of satisfaction level and usage of assistive device in study subjects, a significant relationship was seen for BMI, material type, walker type, distance able to walk each day, usage duration in a day, and time period of disability with p=0.005, 0.004, 0.000, 0.003, 0.006, and 0.000 respectively (Table 6)

Table 5: Significant factors in choosing the walkers

Table 6: Relationship of satisfaction level and usage of assistive device in study subjects

The present study assessed 200 subjects that were using walkers or Adaptive Assistive Rehabilitation Technologies. In all the subjects, questionnaire was used to collect the data concerning their concerns, preferences, and approach of caregivers. There were 79% (n=158) male and 21% (n=42) females in the study. Majority of subjects were 20 years old and aged >40 years. Majority of the subjects had weight of >60 years with 52% (n=104) subjects. Most of the subjects were graduate, married and intermediate. Majority of subjects were professional with 55% (n=110) subjects with 43% (n=86) subjects being employed. Majority of subjects had income of 40,000-50,000 monthly. These data were comparable with the previous studies of Thies SB et al⁵ in 2018 and Ramadass S et al⁶ in 2020 where authors assessed subjects with demographic data comparable to the present study in their respective studies.

It was seen that for factors affecting walker use in study subjects, most common reason for using walker was temporary after surgery/fracture, most of subjects were disabled for 0-2 years with 77% (n=154) subjects, was used for 0-3 hours by 41% (n=82) subjects, and majority subjects covered distance of 100-500 m in a day as reported by 52% (n=104) subjects. Most common effect of long-term walker use was mobility detention reported by 75% (n=150) subjects, most common difficulty on not using walker was dependence reported by 65% (n=130) subjects. Most common reason for walker prescription was Rehabilitation following hospitalization/stroke as reported by 64% (n=128) subjects. Most commonly used walker was standard followed by folding. Most comfortable material was aluminium as reported by 49% (n=98) subjects followed by cast iron used by 40% (n=80) subjects. Factors that governed walker choice were easy transport and storage followed by independent activity performance, weight, no strain to wrist, durable body, sweat resistant grip, and adjustable height. Problems encountered on not using walker were slow and tiring to pick and settle and problems in learning balance reported by 100% (n=200) subjects and inability to carry things reported by 65% (n=130) subjects. These results were consistent with the findings of Graafmans WC et al⁷ in 2003 and Van der Esch M⁸ in 2003 where results for affecting walker use in study subjects reported by authors was comparable to the results of the present study.

The study results showed that for experience for walker use at different places, confidence to use assistive ambulatory devices at various locations, 69% (n=138) subjects reported that their friends and family accept in same way, 100% (n=200) reported that they experience a better quality of life and feel that their life is normal, 46% (n=92) subjects reported risk of injuring oneself, and 32% (n=64) subjects reported no difficulty in acceptance of using the device. Concerning the experience of dependence on assistive devices, all 100% (n=200) subjects reported they are dependent for going to living area and bedroom. 68% (n=136) reported needing assisting devices outside the building, and 23% (n=46) reported needing them for shopping complexes. For association in difficulties faced with walker use and reason for using the device, significant results were highest for tendency to fall followed by unable to participate in community, dependence for work, unable to walk around and participate in community with p=0.0001. These findings were in agreement with the results of Thomas S et al⁹ in 2010 and Bateni H et al¹⁰ in 2007 where results for experience for walker use at different places and association in difficulties faced with walker use and reason for using the device comparable to the present study was also reported by the authors in their studies.

On assessing the significant factors influencing the selection of the walker, most significant factors were ease of use, durability, safety, effectiveness, weight, and dimension as reported by 31% (n=62) subjects followed by comfort reported by 25% (n=50) subjects, and adjustments as reported by 10% (n=10) subjects respectively (Table 5). Concerning the relationship of satisfaction level and usage of assistive device in study subjects, a significant relationship was seen for BMI, material type, walker type, distance able to walk each day, usage duration in a day, and time period of disability with p=0.005, 0.004, 0.000, 0.003, 0.006, and 0.000 respectively. These results were in line with the findings of Melzed D et al¹¹ in 2004 and Viegas V et al¹² in 2018 where most significant factors affecting walker selection reported by authors were ease of use, durability, safety, effectiveness, weight, and dimension which was similar to the results of the present study.

Considering its limitations, the present study concludes that there is a need of improvement in public infrastructure, emotional support, training of caregivers, and customization of designs of the walker to ultimately promote the mobility and independence in walker using subjects.

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