Background: The purpose of this paper is to systematically review the evidence for the provision of walkingframes to improve mobility for older people.Objectives: To investigate the types of frames used and the processes involved in prescribing frames, andto determine the effects of using a frame.Methods: The AMED, CINAHL, Embase, and MEDLINE Electronic databases were searched using keyterms between 1990 and January 2011. Research papers reporting outcomes about the effectiveness ofwalking frames in relation to mobility for older people were eligible for inclusion. Sixteen papers wereincluded under the criteria applied, representing 17% of the studies identified. A range of study designswas included. Double-blind review was carried out and quality assessment conducted using CASP criticalappraisal tools. Synthesis of literature was carried out on a narrative basis through the development ofthemes in relation to types of frames, user’s perspective, falls prevention, effects on gait and balance, andphysiological effects.Results: The evidence reviewed is largely of poor quality. Users obtain walking frames from many sources.The evidence reviewed neither proves nor disproves their effectiveness in the prevention of falls. Walkingframe use does have an effect on gait patterns and some physiological outcomes. The effect on postureand balance remains unclear.Conclusions: A need for clinical guidelines in relation to provision of walking frames has been identified. Thetherapeutic use of walking frames to improve physical fitness merits further research as well as longer-termstudies to evaluate the effects over time.
Bibliographical noteReference text: Close J. Prevention of falls in older people. Disabil Rehabil.
2 Gillespie LD, Robertson MC, Gillespie WJ, Lamb SE, Gates
S, Cummings RG, et al. Interventions for preventing falls in
older people living in the community. Cochrane Database Syst
3 Tinetti ME, Baker DI, McAvay G, Claus EB, Garrett P, Loch
ML, et al. A multi-factorial intervention to reduce the risk of
falling among elderly people living in the community. Boston
Med Surg J. 1994;331:821–7.
4 WHO strategy document. A strategy for active healthy ageing and
old age care in the Eastern MediterraneanRegion. Available from:
www.emro.who.int/dsal dsa543.pdf (Accessed 8 August 2011).
5 Skelton DA, Dinan S. Exercise for falls management:
rationale for an exercise programme to reduce postural
instability. Physiother Theory Pract. 1999;15:105–20.
6 Dinan S, Exercise for vulnerable older patients, In: Young A,
Harries M, editors. Exercise prescription for patients. London:
Royal College of Physicians; 2001.
7 Harkins KJ, Mulley GP. Walking aids. CME Geriatr Med.
8* Gooberman-Hill R, Ebrahim S. Making decisions about
simple interventions: older people’s use of walking aids. Age
9 van der Esch M, Heijmans M, Dekker J. Factors contributing
to possession and use of walking aids among persons with
rheumatoid arthritis and osteoarthritis. Arthritis Care Res.
10 Anslow R, Pinnington LL, Pratt DJ, Spicer J, Ward CD,
Weyman N. Stability and manoeuvrability of wheeled walking
frames. Physiotherapy. 2001;87(Pt 8):402–12.
11 Edwards NI, Jones DA. Ownership and use of assistive devices
amongst older people in the community. Age Ageing. 1998;27:463–8.
12* Bateni H, Maki BE. Assistive devices for balance and
mobility: benefits, demands and adverse consequences. Arch
Phys Med Rehabil. 2005;86:134–43.
13 Ivanoff SD, Sonn U. Changes in the use of assistive devices among
90-year-old persons. Aging Clin Exp Res. 2005:17;246–51.
14 Aveyard H. Doing a literature review in health and social care.
A practical guide. Glasgow: Open University Press; 2007.
15 Sackett DL, Rosenberg WM, Muir Gray JA, Haynes RB,
Richardson WS. Evidence based medicine. What it is and what
it isn’t. BMJ. 1996;312:71–2.
16 Public Health Resource Unit. CASP critical appraisal tools.
Available from: http://www.sph.nhs.uk/what-we-do/publichealth-
(Accessed 19 September 2010).
17 Oxford Centre for Evidence-based Medicine — Levels of
Evidence. 2009 Mar. Available from: http://www.cebm.net/
index.aspx?o51025 (Accessed 08 September 2010).
18 Haines T, Brown C, Morrison J. Public provision of fourwheeled
walkers: contingent valuation study of economic
benefit. Australas J Ageing. 2008;27(Pt 3):161–4.
19 Stevens JA, Thomas K, The L, Greenspan AI. Unintentional
fall injuries associated with walkers and canes in older adults
treated in US Emergency departments. J Am Geriatr Soc.
20 Bryant MS, Rintala DH, Lai EC, Raines ML, Protas EJ.
Evaluation of a new device to prevent falls in person’s with
Parkinson’s disease. Disabil Rehabil. 2009;4(Pt 5):357–63.
21* Eggermont LH, van Heuvelen MJ, van Keeken B, Scherder
EJ. Walking with a rollator and the level of physical intensity
in adults aged 75 years of age and older. Arch Phys Med
Rehabil. 2006;87(Pt 5):733–6.
22 Mahoney J, Euhardy R, Carnes M. A comparison of a 2
wheeled and a 3 wheeled walker in a geriatric population. J
Am Geriatr Soc. 1992;40:208–12.
23* Probst VS, Troosters T, Coosemans I, Spruit MA, Pitta F,
Decramer M, et al. Mechanisms of improvement in exercise
capacity using a rollator in patients with COPD. Chest.
2004;126(4):1102–7. Available from: http://chestjournal.
chestpubs.org/content/126/4/1102.full (Accessed 28 July 2010).
24* Protas EJ, Raines ML, Tissier S. Comparison of spatiotemporal
and energy cost of the use of 3 different walkers and
unassisted walking in older adults. Arch Phys Med Rehabil.
25 Anderson DA, Roos BA, Stanziano DC, Gonzalez NM,
Signorile JF. Walker use but not falls, is associated with lower
physical functioning and health of residents in an assistedliving
environment. Clin Interv Aging. 2007;2:123–7.
26 Cetin E, Muzembo J, Pardessus V, Puisieux F, Thevenon A.
Impact of different types of walking aids on the physiological
energy cost during gait for elderly individuals with several
pathologies and dependent on a technical aid for walking. Ann
Phys Med Rehabil. 2010;53:399–405.
27* Liu H, McGee M, Wang W, Persson M. Comparison of gait
characteristics between older rolling walker users and older
potential walker users. Arch Gerontol Geriatr. 2009;48:276–
28* Liu H, McGee M, Prati V, Garrison K, FuQ. Comparison of
standing balance parameters between rolling walker users and
potential rolling walker users: a pilot study. Phys Occup Ther
Geriatr. 2009;27(Pt 4):298–309.
29 Liu H, Grando V, Zabel R, Nolen J. Pilot study evaluating
fear of falling and falls among older rolling walker users. Int J
Ther Rehabil. 2009;16(Pt 12):670–5.
30 Lucki K, Bach M, Banzer W. Walker use affects times get up
and go and gait speed measures. J Am Geriatr Soc. 2009;57(Pt
31* Roomi J, Yohannes AM, Connolly MJ. The effect of walking
aids on exercise capacity and oxygenation in elderly patients
with chronic obstructive pulmonary disease. Age Ageing.
32* Vogt L, Lucki K, Bach M, Banzer W. Rollator use and
functional outcome of geriatric rehabilitation. J Rehabil Res
Dev. 2010;47(Pt 2):151–6.
33* Liu H. Assessment of rolling walkers used by older adults in
senior living communities. Geriatr Gerontol Int. 2009;9:124–
34 Charron PM, Kirby RL, MacLeod DA. Epidemiology of
walker related injuries and deaths in the United States. Am J
Phys Med Rehabil. 1995;74(Pt 3):237–40.
35 Graafmans WC, Lips P, Wijlhuizen GJ, Pluijm SM, Bouter
LM. Daily activity and the use of a walking aid in relation to
falls in elderly people in a residential care setting. Z Gerontol
36 Gupta R, Goldstein R, Brooks D. The acute effects of a
rollator in individuals with COPD. J Cardiopul Rehabil.
37 Honeyman P, Barr P, Stubbing DG. Effect of a walking aid on
disability, oxygenation, and breathlessness in patients with
chronic airflow limitation. J Cardiopul Rehabil. 1996;16:63–7.
38 Brooks LL, Wertsch JJ, Duthie EH. Use of devices for
mobility by the elderly. Wis Med J. 1994;93(Pt 1):16–20.
39 Takanokura M. Optimal handgrip height of four wheeled
walker on various road conditions to reduce muscular load for
elderly users with steady walking. J Biomech. 2010;43(Pt
40 Nabizadeh SA, Hardee TB, Towler MA, Chen VT, Edlich RF.
Technical considerations in the selection and performance of
walkers. J Burn Care Rehabil. 1993;14:182–8.
- Walking frames