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Currently, an estimated 6.1 million community-dwelling adults use mobility devices, including canes, walkers, and crutches, and two-thirds of those persons are older than 65 years.1 With the growing number of older adults in the community and the increasing number of those adults with multiple chronic conditions, disability and the resultant mobility problems are anticipated to become even more widespread.2 Of adults older than 65 years, 10 percent use canes and 4.6 percent use walkers.1
SORT: KEY RECOMMENDATIONS FOR PRACTICE
| Clinical recommendation | Evidence rating | References |
|---|---|---|
| Assistive devices can be prescribed to improve balance, reduce pain, and increase mobility and confidence. | C | 3, 4 |
| Because most patients obtain their assistive device without recommendations or instructions from a medical professional, assistive devices should be evaluated routinely for proper fit and use. | C | 7, 9 |
| When only one upper extremity is needed for balance or weight bearing, a cane is preferred. If both upper extremities are needed, crutches or a walker is more appropriate. | C | 10 |
| The correct height of a cane or walker is at the level of the patient's wrist crease, as measured with the patient standing upright with arms relaxed at his or her sides. When holding the device at this height, the patient's elbow is naturally flexed at a 15- to 30-degree angle. | C | 13 |
A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to https://www.aafp.org/afpsort.xml.
Assistive Devices
Assistive devices can be prescribed to broaden a patient's base of support, improve balance and stability, or redistribute weight from the lower limbs to help alleviate joint pain or compensate for weakness or injury. The goals of assistive device use are to improve independent mobility, reduce disability, delay functional decline, and decrease the burden of care.3,4 Patients using assistive devices have reported improved confidence and feelings of safety, resulting in increased activity levels and independence. There also may be physiologic benefits of assistive device use, including improved cardiorespiratory function, enhanced circulation, and prevention of osteoporosis.3 However, there are insufficient high-quality studies evaluating the impact of specific assistive devices on mobility outcomes and fall prevention.