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Older adults have higher rates of emergency department admissions when compared to their younger counterparts. Mobility is the ability to move around but also encompasses the environment and the ability to adapt to it. Walking aids can be used to improve mobility and prevent falls. According to international guidelines, they must be available in Geriatric Emergency Department. This study aims to evaluate the effectiveness of a program of training and provision of walking aids (WA), associated or not with telemonitoring, on mobility, quality of life, fear of falling, and risk of falls up to 3 months in older adults cared for in an emergency department.
A randomized clinical trial will be carried out in the emergency department of Hospital SÃrio-Libanês. Participants will be randomized and allocated into three intervention groups, as follows: A) Walking aid group; B) Walking aid and telemonitoring group; C) Control group. Patients will undergo a baseline evaluation encompassing sociodemographic and clinical data, mobility in life spaces (Life Space Assessment), gait speed, muscle strength, functionality (Barthel Index, Katz index, and Lawton-Brody Scale), quality of life (Euro Quality of Life Instrument-5D), fear of falling (Falls Efficacy Scale International), history of falls, cognition (10-Point Cognitive Screener) and mood (15-point Geriatric Depression Scale) before the intervention. Gait time and fear of falling will be assessed again after the intervention. Finally, mobility in life spaces, functionality, quality of life, fear of falling, history of falls, cognition, and mood will be assessed 3 months after discharge from the geriatric emergency department through a telephone interview.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Walking aid (WA) group | Experimental | Participants will receive the walking aid and training in the use of the device. |
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| Walking aid with telemonitoring (WAT) group | Experimental | Participants will receive the walking aid and training in the use of the device associated with telemonitoring. |
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| Control group | Other | Participants will receive verbal guidance and printed material. |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Walking aid | Device | A physiotherapist will identify the mobility needs and will indicate the most appropriate walking aid (cane or walker). |
|
| Measure | Description | Time Frame |
|---|---|---|
| Life-Space Assessment (LSA) | LSA is a scale which allows the characterization of mobility in life-spaces specifically frequency, need for mobility aids and the help of third party in the last 4 weeks | At baseline and after completion of the 3 and 6 months intervention to assess change |
| Falls Efficacy Scale International (FES-I) | Assesses fear of falling | At baseline, immediately after the intervention and after completion of the 3 and 6 months intervention to assess change |
| Measure | Description | Time Frame |
|---|---|---|
| Timed Up and Go test (TUG) | TUG evaluate mobility, balance, gait, and risk of falling | At baseline and immediately after the intervention |
| One-minute sit-to-stand test | Functional capacity assessment by sit and stand completely in a chair (as often as possible during 1 minute) |
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Inclusion Criteria:
Exclusion Criteria:
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Hospital SÃrio Libanês | São Paulo | São Paulo | 01308-050 | Brazil |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 29254407 | Background | Kennedy RE, Williams CP, Sawyer P, Lo AX, Connelly K, Nassel A, Brown CJ. Life-Space Predicts Health Care Utilization in Community-Dwelling Older Adults. J Aging Health. 2019 Feb;31(2):280-292. doi: 10.1177/0898264317730487. Epub 2017 Sep 14. | |
| 20159128 | Background | Shimada H, Sawyer P, Harada K, Kaneya S, Nihei K, Asakawa Y, Yoshii C, Hagiwara A, Furuna T, Ishizaki T. Predictive validity of the classification schema for functional mobility tests in instrumental activities of daily living decline among older adults. Arch Phys Med Rehabil. 2010 Feb;91(2):241-6. doi: 10.1016/j.apmr.2009.10.027. |
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| ID | Term |
|---|---|
| D051346 | Mobility Limitation |
| D004630 | Emergencies |
| ID | Term |
|---|---|
| D012816 | Signs and Symptoms |
| D013568 | Pathological Conditions, Signs and Symptoms |
| D020969 | Disease Attributes |
| D010335 | Pathologic Processes |
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This study will be blind for the researchers involved in the post-telemonitoring assessments. Also, the data will be analyzed by a researcher who is not involved in the interventions or the assessments.
| Telemonitoring | Other | Telemonitoring will occur every two weeks for three months after the emergency department discharge, through video call (about 15 minutes). On these opportunities, the importance of using mobile devices and the guidance on safe gait will be reinforced. |
|
| Guidance on safe walking and risk of falling | Other | Participants will receive verbal guidance and printed material with guidance on safe walking and fall prevention. |
|
| At baseline and after completion of the 3 and 6 months intervention to assess change |
| Katz index | Katz index is a scale which evaluate basic activities of daily living | At baseline and after completion of the 3 and 6 months intervention to assess change |
| Barthel index | Barthel index is a scale which evaluates the autonomy for self-care, in addition to mobility | At baseline and after completion of the 3 and 6 months intervention to assess change |
| Lawton-Brody scale | Lawton-Brody scale evaluate Instrumental activities of daily living | At baseline and after completion of the 3 and 6 months intervention to assess change |
| Euro Quality of Life Instrument-5D (EQ-5D) | EQ-5D evaluate quality of life in five health dimensions: mobility, self-care, usual activities, pain/discomfort, and anxiety/depression, and self-rated health on a visual analog scale | At baseline and after completion of the 3 and 6 months intervention to assess change |
| Geriatric Depression Scale (GDS-15) | Assesses mood disorders | At baseline and after completion of the 3 and 6 months intervention to assess change |
| 10-Point Cognitive Screener (10-CS) | 10-CS consists of a brief cognitive screening which evaluate temporal orientation, verbal fluency and three-word recall | At baseline and after completion of the 3 and 6 months intervention to assess change |
| Fall History | Fall history evaluate occurrence of falls (including data location, associated injuries, need for special care after the fall) and the total number of falls | At baseline and after completion of the 3 and 6 months intervention to assess change |
| 27288857 | Background | Brown CJ, Kennedy RE, Lo AX, Williams CP, Sawyer P. Impact of Emergency Department Visits and Hospitalization on Mobility Among Community-Dwelling Older Adults. Am J Med. 2016 Oct;129(10):1124.e9-1124.e15. doi: 10.1016/j.amjmed.2016.05.016. Epub 2016 Jun 8. |
| 22809497 | Background | van den Berg N, Schumann M, Kraft K, Hoffmann W. Telemedicine and telecare for older patients--a systematic review. Maturitas. 2012 Oct;73(2):94-114. doi: 10.1016/j.maturitas.2012.06.010. Epub 2012 Jul 17. |
| 15641004 | Background | Bateni H, Maki BE. Assistive devices for balance and mobility: benefits, demands, and adverse consequences. Arch Phys Med Rehabil. 2005 Jan;86(1):134-45. doi: 10.1016/j.apmr.2004.04.023. |
| 41269694 | Derived | Polesel FS, Denadai S, Morinaga CV, Madalena IC, Aliberti MJR, Henrique EA, de Andrade-Junior MC, Nucci RAB, Yamaguti WP, Curiati PK, Righetti RF. Walking Aids and Locomotion Training in the Emergency Department: A Randomized Clinical Trial. JAMA Netw Open. 2025 Nov 3;8(11):e2544535. doi: 10.1001/jamanetworkopen.2025.44535. |
| 39083494 | Derived | Polesel FS, Denadai S, Aliberti MJR, Morinaga CV, Andrade-Junior MC, Madalena IC, Yamaguti WP, Curiati PK, Righetti RF. Training and provision of mobility aids to promote autonomy and mobility of older patients in a geriatric emergency department: A protocol for a randomized controlled trial. PLoS One. 2024 Jul 31;19(7):e0304397. doi: 10.1371/journal.pone.0304397. eCollection 2024. |