Five things to know about prescribing walking aids

Mobility limitations affect more than 2.7 million Canadians and are the third most prevalent cause of disability1. Patients frequently obtain walking aids that are inappropriate or used incorrectly2 in part due to a patchwork of coverage for occupational and physiotherapy. Clinicians’ awareness of walking aids can be transformative to patients’ lives. There is stigma and shame associated with the use of walking aids. This relates to a fear of being perceived as “crippled,” concern that they cause dependency, and the false belief that mobility devices add to functional decline3. In reality, they can improve walking speed and enable daily functioning2. Single point canes are best for balance. Offset and quad canes allow patients to shift more weight onto the cane4, 5. The cane should be held in the hand opposite to the weak leg and advanced in unison with it. The affected leg should hit the ground simultaneously with the cane held on the opposite side. Patients should be instructed to push their weight into the cane in order to off-load their weight from the affected limb while concentrating on keeping their spine straight. This can off-load nearly two-thirds of the weight that would otherwise go into the affected leg3. Walkers provide a large base of support for patients who have poor balance or who have bilateral lower limb weakness. A two-wheel rolling walker is easier to maneuver than a standard walker with no wheels. A four-wheel rolling walker (rollator) can be used by higher-functioning individuals. Rollators are the least stable of walkers, but they allow for rest breaks2, 5. Cane or walker height should be at the level of the patient’s greater trochanter or the distance from the ground to the patient’s wrist crease with their arms hanging at their side3, 5. Read: Hip replacement technique gets patients back on their feet sooner Dr. Iris Gorfinkel is a family physician in Toronto, Patricia Dickson is a clinical supervisor and advanced practice occupational therapist at Sunnybrook Health Sciences Centre and Dr. Bob Bell is an orthopedic surgeon and previously served as deputy minister of health and long-term care for Ontario. References: Statistics Canada: Canadians with a mobility disability , Dec 3, 2020 https://www150.statcan.gc.ca/n1/pub/11-627-m/11-627-m2020085-eng.htm accessed Oct. 15, 2021 Lam R. Practice tips: choosing the correct walking aid for patients. Can Fam Physician. 2007; 53(12):2115-2116. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2231545/# Resnik L, Allen S, Isenstadt D, Wasserman M, Iezzoni L. Perspectives on use of mobility aids in a diverse population of seniors: implications for intervention. Disabil Health J. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2768139/ Bertrand, K., Raymond, M, Miller, W, Ginis, K & Demers, L. Walking Aids for Activity & Participation: A Systematic Review. Am J Phys Med Rehabil 2017; 96: 894-903. https://doi.org/10.1097/PHM.0000000000000836 Sehgal, Mandi ; Jacobs, Jeremy ; Biggs, Wendy S. Mobility Assistive Device Use in Older Adults. Am Family Phys, 2021, 103 (12), p.737-744

Five things to know about prescribing walking aids

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