# Walking Aids and Locomotion Training in the Emergency Department: A Randomized Clinical Trial

## TL;DR

Training and providing walking aids in the emergency department improves mobility and reduces fear of falling in older adults, but adding telemonitoring doesn't offer extra benefits.

## Contribution

This study is the first to evaluate the effectiveness of walking aid training in the emergency department for older adults.

## Key findings

- Training and provision of walking aids significantly improved mobility and fear of falling after 90 days.
- Telemonitoring did not provide additional benefits compared to training alone.
- The intervention had no significant effect on gait, functional capacity, or quality of life.

## Abstract

Does a program of training and provision of walking aids in the emergency department, with or without telemonitoring, improve mobility in life spaces and fear of falling in older adults after 90 days?

In this randomized clinical trial of 75 adults 65 years or older, the intervention groups had a significant improvement in mobility and fear of falling at 90 days compared with the control group. Telemonitoring did not improve mobility compared with no telemonitoring in the intervention groups.

A program of training and provision of walking aids improved mobility and fear of falling among older adults discharged from the emergency department.

This randomized clinical trial evaluates the effectiveness of training and provision of walking aids delivered by physiotherapists, with or without telemonitoring, on mobility among older adults in the emergency department.

This randomized clinical trial evaluates the effectiveness of training and provision of walking aids delivered by physiotherapists, with or without telemonitoring, on mobility and fear of falling among older adults in the emergency department.

Mobility limitations are common in older adults and impact quality of life and social interaction. Walking aids can improve mobility and prevent falls but require oversight and training. Despite being recommended by geriatric emergency department (ED) guidelines, their effectiveness in this setting has not been studied to date.

To evaluate the effectiveness of training and provision of walking aids, with or without telemonitoring, on mobility, fear of falling, gait, functional capacity, quality of life, cognition, depression, and occurrence of falls in older adults after an ED visit compared with safe ambulation recommendations only.

This randomized clinical trial was conducted at the Geriatric ED of Hospital Sírio-Libanês, São Paulo, Brazil, from July 20 to December 16, 2023, with a 90-day follow-up. Participants were patients 65 years or older who were discharged from the geriatric ED with at least 1 indication for walking aids according to the institutional protocol. Researchers involved in postintervention assessment and statistical analyses were blinded to group allocation.

Seventy-five participants were allocated to 1 of 3 groups: control, walking aids (WA), or walking aids with telemonitoring (WAT). All participants received safe ambulation recommendations. Intervention groups (WA and WAT) were assessed and trained in device use by a physiotherapist. The WAT group received telemonitoring follow-up to promote adherence.

The primary outcomes were improved life-space mobility as assessed by the Life Space Assessment and fear of falling as assessed by the Falls Efficacy Scale International at 90 days follow-up. Secondary outcomes included gait, functional capacity, quality of life, cognition, depression, and occurrence of falls.

A total of 75 older adults were enrolled (mean [SD] age, 81.3 [7.7] years; 40 [53.3%] female). At 90 days, the WA group had significant improvement in life-space mobility (mean difference [MD], 12.77; 95% CI, 1.06-24.54; P = .03), fear of falling (MD, –5.60; 95% CI, –9.06 to –2.14; P = .002), and 1-minute sit-to-stand test (MD, 8.45; 95% CI, 4.34-12.56; P = .001) compared with the control group. No significant improvements were observed in any of these outcomes in the WAT group compared with the WA group.

In this randomized clinical trial, training and provision of walking aids for older adults in the ED improved mobility and fear of falling as long as 90 days after discharge. The addition of telemonitoring did not result in additional benefits. This study highlights the role of a specialized physiotherapy intervention to optimize outcomes in older adults in the ED.

ClinicalTrials.gov Identifier: NCT05950269