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Physio Network
Steady steps: walking aids and falls prevention with Alex Roberts
In this episode with Alex Roberts, we explore the world of walking aid prescription, adherence, and falls prevention in physiotherapy. We examine the importance of selecting the right aids, strategies for improving adherence, and the prevalence of falls among different patient populations. Additionally, we discuss innovative solutions like magnetic walking aids and their potential to enhance adherence and reduce falls risk.
Alex Roberts studied at the University of Sydney has worked as a physiotherapist in the NHS in the UK and Westmead Hospital in Australia and has a passion for falls prevention.
Magnetic Walking Aid research article link: https://pubmed.ncbi.nlm.nih.gov/38019042/#:~:text=Conclusion%3A%20The%20results%20of%20this,drops%20when%20compared%20to%20SWAs.
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Our host is @sarah.yule from Physio Network
Physiotherapists are the primary prescribers of mobility aids when they play a vital role, or we play a vital role in our healthcare system. As mobility aids allow patients and members of our community who would not be able to mobilise, do so safely. So safer use of walking aids can lead to earlier discharge dates from hospital systems, increase independence, reduce falls risks, and increase patients' capacity to participate in exercise interventions.
SPEAKER_02:Today we are speaking to Alex Roberts, who is a physiotherapist who has explored and completed research in the field of gate aid prescription, and he's founded a company called Pragnetics, which is dedicated to falls prevention. In this episode of Physio Explained, we explore the impact of falls on the individual, as well as the wider healthcare system. What roles does physio play in falls prevention and in gate aid prescription? Lots to think about in today's episode. I'm Sarah Ewell, your co-host, and this is Physio Explained. Well, hi Alex, welcome to the podcast.
SPEAKER_00:Thanks Sarah, it's an honour to be here.
SPEAKER_02:Talk to me about your journey from theory to practice of mobility aids.
SPEAKER_00:Yes, so as you know, I'm a physiotherapist and so during my time as a physiotherapy, I've often struggled with prescribing walking aids and then having patients use these walking aids consistently, you know, People using their walking aids can be quite difficult to monitor, especially in the community or in a patient's room. And so I've always kind of had that struggle of how do we really know they're using their walking aid in their room after we prescribed it?
SPEAKER_02:And I suppose looking at the evidence, how big is the problem of falls?
SPEAKER_00:Yeah, falls are a huge problem. They remain a pressing health issue in both the community and the healthcare system, particularly for those over the age of 65, likely to worsen due to the growing and ageing population. Just to give your listeners an idea of the prevalence of falls in Australia, approximately one in three adults over the age of 65 fall each year, and that number climbs up to one in two adults over the age of 80. These falls can have a massive impact on the individual and on the healthcare system as fallers enter into that feedback or into that disability spiral where they often get into more falls.
SPEAKER_02:Obviously, that'll have significant impacts on both the individual and on the healthcare system.
SPEAKER_00:That's right, yeah. And I often find stats can be helpful to put things in perspective. So, on the individual level, we know that if someone sustains a more common injury as a result of a neck or femur fracture, they can have a 20% mortality rate after one year. And then if it's a more rare injury like a fractured pelvic ring, that mortality rate can jump up to 40% for those over 65 within years. three-year period. So, it can be quite devastating on the individual. And it's all about that feedback loop where you fall, you become less mobile, you become afraid of falling, and then you do less and fear falling. And then when you're more afraid of falling, then you end up falling again and then getting that vicious spiral.
SPEAKER_02:And as you say, it's sounding like based on the fact that these falls are having such a big impact on the individual, the role of physiotherapy is ever important. Yeah. Talk to me about, I suppose, where mobility aid use comes into that, either the prevention or the management post-fall.
SPEAKER_00:Yeah. So, physiotherapists are the primary prescribers of mobility aids and they play a vital role, or we play a vital role in our healthcare system. As mobility aid allow patients and members of our community who would not be able to mobilize, do so safely. So, safer use of walking aids can lead to earlier discharge dates from hospital systems, increase independence, reduce falls risks, and it increased patients' capacity to participate in exercise interventions. But despite these benefits, walking aids are rendered useless if patients don't adhere to their walking aid device in their prescribed manner. So adherence to walking aid use within hospitals and community settings can be difficult to monitor, like I mentioned before. And I'm sure, Sarah, you've had that anecdotal experience where you have a stubborn client who refuses to use a walking stick or follow a walker. And they're like, no, it makes me feel old. Oh, no, I don't want to do it. And so there's a kind of that pain point for physiotherapists and that kind of pain point for patients where you've got that kind of two opposing people lighting. But the thing is, you're not the only one. Researchers found that up to 70% of walking aid users in the community who fell did not have their walking aid with them at the time of fall, despite stating that canines help prevent falls, which begs the question, why don't walking aid users have their walking aid with them at the time of fall?
SPEAKER_02:Absolutely. That's a huge statistic. As you say, these things are often multifactorial and it's our role as educators to highlight the importance and obviously also to understand the potential barriers from a patient perspective of why they would want to use that walking aid as well. So what do you feel is the solution? Have you found some strategies that start to address this 70% statistic?
SPEAKER_00:Yeah. So I think there's the kind of two things that physiotherapists can play a role in helping improve mobility aid adherence. You've got that big one, like you mentioned before about education. So when you prescribe a walking aid, make sure you, you know, really explain to the patient what happens if you don't use like the risks associated and really kind of, you know, breaking it down in layman's terms, just so that they really understand. understand it. And yeah, it's not just kind of, I know we all get into the trap where we just give them a walking stick, we size it up, yeah, and then give it to them, let's use this, da-da-da-da, but really taking the time to do it, especially if it's the first time someone's using a walking aid. And then the other thing I think impacts walking aid use is having a walking aid that's accessible, which is where I believe my innovation that I've come up with really tackles that problem.
SPEAKER_02:And what is that innovation?
SPEAKER_00:Yeah, so for a bit of background on it, so... My role as a physiotherapist, I found I was constantly picking up walking sticks off the ground. You know, it's not only is it annoying as a physiotherapist, but it's a huge trip hazard. It means that walking aid users can't access their walking stick. So I was on my way home from a busy hospital schedule. I got into my car, placed my phone on my magnetic car mount, and I couldn't help but wonder why something like this doesn't exist for walking aid users. So I got the cogs turning, you know, when you're in the car, that's when you have time to think in your brain. Did some research and found out it didn't exist. And then one thing led to another and we developed some early stage prototypes for magnetic walking aids.
SPEAKER_02:Fantastic. Find the gap and seek to fill it yourself. And what have you found in terms of your studies of this gate aid or of this magnetic aid?
SPEAKER_00:Yep. So, after we developed a few prototypes, we got some feedback from some patients and it was about working alongside patients to try and see like what they want out of a walking stick and they consistently reported accessibility or Walking sticks dropping on the ground is one of their main barriers to walking aid use. And so we worked alongside them. And then we went ahead and ran a pilot study, which included 20 patients being randomly allocated to, sorry, 40 patients altogether, 20 being allocated to the magnetic walking aid group and 20 being allocated to the stand walking aid group. Then we came up with some made-to-measure Lankart style questions. We strongly agree, agree, disagree that style. I think we also got them to, how many times they dropped their walking aid each day. And yeah, we found that the trial suggested that magnetic walking aids may be an acceptable and inexpensive intervention for improving walking aid accessibility and adherence and reducing walking aid drops compared to standard walking aids. So it's that kind of pathway where if a walking aid is more accessible and it's by your patient bedside, magnetized to a metal plate or in the kitchen or in the bathroom, people are more likely to adhere to their walking aid just because it's within... hands reach or with an eye shot. And also, we found it prevented walking aid drops just having a secure position. And so, yeah, that was some of the results from our study.
SPEAKER_02:Fantastic. So, you've sort of addressed that barrier of not having a walking aid. And have you noticed it's translated across into reduced falls or it sounds like more just prevention of dropping, which presumably will hopefully translate into a reduction in falls?
SPEAKER_00:That's it. Yeah, yeah, yeah. So, it's early stage studies. So, we hope to have larger scale studies where we can start to delve into whether walking aid drops and increasing walking aid adherence does relate to falls prevention. But yeah, we hope to, in the future, run some larger scale studies. But the previous research does suggest that if walking aids are used correctly, then yeah, they can reduce falls by up to 40%. That's a good Australian study that found that. And so... Yeah, we hope to kind of align our practices with that. And yeah, we hold great promise for this innovation, magnetic walking aids.
SPEAKER_01:This podcast is sponsored by Cliniko.
SPEAKER_02:It's sounding like in that sort of pathway to falls prevention, the first one is actually selling why there is a relevance to use a walking aid. And I think something you mentioned before is as physios, sometimes we forget that it might be our hundredth or thousandth time of actually prescribing a gait aid or giving an exercise, but for many, it's their first time receiving that bit of education as well. So, it's not to be taken lightly and we must sort of honour that each time too.
SPEAKER_00:Yeah, that's it. And it's that behavioural change process, you know, where you got to go through the pre-contemplation, contemplation phase. You know, if it's not a habit, you might break it. And, you know, not everyone, but a lot of people that require a walking aid may be of the older generation. So, you know, they might have some memory issues as well. So, But yeah, it's important for us as physiotherapists just to be patient and educate and make sure of breaking down as many barriers as possible to walking aid use because we are the primary prescribers. And yeah, it's within our role to make sure people are using their walking aids safely.
SPEAKER_02:Absolutely. So, we're addressing that adherence component with really strong education. And then it sounds like this magnetic aid is addressing in part that accessibility issue quite effectively. Absolutely. What have you found are the longer term uses of it?
SPEAKER_00:Yeah. So with the magnetic walking aid, we find that it translates from not just in the hospital system, but to the home environment. So the idea is that you make your environment magnetic friendly. So once you've got your magnetic attachment on your walking aid, you then make the environment at home magnetic friendly. And then you can just stick it like at the front door of the bedroom or bathroom and things like that. And then you're set up for life, really. And then you've got all those housing spots installed. to help prevent your walking aid from dropping on the floor. And so, yeah, that's kind of what we see this innovation really helping people, those people that can't, you know, when you think of the Berg balance tests, those people that can't pick things up off the floor, people that struggle with adherence. And yeah, they're kind of the main indicators for people that might benefit from this and where we can see some long-term benefits for users.
SPEAKER_02:Fantastic. It's also sounding like in addressing those having a magnetic environment, hopefully in that you're also looking at all of those other environmental factors that will contribute to falls risk. And so that sort of further highlights that overall wide view and wide lens approach we take in patient care of looking at what education we can do, what accessibility might be, what the person's environment is, and hopefully in time we can be far more successful at hopefully getting that number down, improving the statistics.
SPEAKER_00:Yeah, yeah, that's exactly it. Get the number down and then reduce faults.
SPEAKER_02:Absolutely. Absolutely. Well, Alex, thank you so much for your time today. I think those are some fantastic points for us to consider in prevention of falls and perhaps in how we integrate that into clinical practice. So thank you for your time.
SPEAKER_00:Thank you so much, Sarah. It's been a pleasure.