Simple Mobility Tests Predict Use of Assistive Devices in Older Adults

Abstract

Background: Assistive devices (ADs) for ambulation are commonly provided to improve safety and independence in older adults. Despite the common use of these devices, there are no standard prescribing guidelines, and non–health care providers, including caregivers and family members, often make decisions about the need for ADs. Identifying factors or a single screening test associated with AD use would benefit clinicians and non–health care caregivers in making decisions to adopt an AD for patients, clients, and family members. Purpose/Objectives: The purpose of this cross-sectional study was to identify the test that best predicts ADs for ambulation and non-AD use among community-dwelling individuals. Methods: Eighty-five older adults (81.6 ± 8.2 years old) who underwent outpatient physical therapy participated in this study. They participated in a series of tests, including the Timed Up and Go, handgrip and quadriceps strength, the 30-second chair-rise test, the 5-m fast gait speed, the Functional Independence Measure, the locomotive syndrome tests (stand-up test, 2-step test [2ST], and the Locomo-5 Checklist), and numeric pain scales. Mann-Whitney U tests were used to identify differences between those who did and did not use an AD for ambulation. Logistic regression analyses were used to examine which test best predicted AD use. Results: 80% of participants (n = 68) used an AD for ambulation. There were significant differences in all test variables between users and nonusers (P = .033 to P < .001), except for quadriceps strength, age, and pain (all P > .05). Only the 2ST was a significant predictor of AD use, with a cutoff distance of the toe-to-toe stride shorter than 93% of body height (sensitivity: 72%, and specificity: 82%, P = .048). Discussion: Simple functional measures differed between those who did and did not use ADs for ambulation; however, only the 2ST predicted AD status. Individuals who cannot step 93% of their body height may be appropriate for an AD. Conclusions: If comprehensive clinical evaluations are not available to make decisions about AD use, the 2ST can be used to make clinical recommendations for an AD for ambulation.