From the Guidelines
A rolling walker (rollator) would be the most appropriate assistive device for this 83-year-old female patient with diabetic neuropathy and bilateral knee osteoarthritis. This recommendation is based on the need for optimal stability and support while allowing for a more natural gait pattern, which is crucial for patients with poor balance and knee pain. The rollator's features, such as hand brakes, a seat for rest, and a basket for carrying items, address the patient's specific needs and promote mobility and independence.
According to the guidelines for adult stroke rehabilitation and recovery 1, ambulatory assistive devices, such as canes or walkers, should be used to help with gait and balance impairments, as well as mobility efficiency and safety. However, a more recent study on the diagnosis and treatment of active Charcot neuro-osteoarthropathy in persons with diabetes mellitus 1 suggests that assistive devices, such as walkers, can be used to reduce pressure on the affected limb, risk of falls, and time to remission.
The benefits of using a rolling walker for this patient include:
- Optimal stability with four points of contact
- A more natural gait pattern than a standard walker
- Hand brakes for safety
- A seat for rest periods when fatigue or pain increases
- A basket for carrying personal items
In contrast, a cane provides minimal support, and a standard walker requires lifting, which may be challenging for an elderly patient with multiple comorbidities. Therefore, a rolling walker is the most suitable option for this patient, as it offers substantial stability without requiring upper body strength.
From the Research
Assistive Mobility Devices for Older Adults
The patient in question is an 83-year-old female with diabetic neuropathy and osteoarthritis of both knees, experiencing poor balance and knee pain that has led to a decline in physical endurance. Considering her conditions, the most appropriate assistive device would be one that provides stability, supports her balance, and reduces the strain on her knees.
Characteristics of Assistive Devices
- Canes can improve standing tolerance and gait by off-loading a weak or painful limb, but they require sufficient balance, upper body strength, and dexterity to use safely 2.
- Walkers provide a large base of support for patients with poor balance or bilateral lower limb weakness, and a two-wheel rolling walker is more functional and easier to maneuver than a standard walker 2.
- Four-wheel rolling walkers (rollators) can be used by higher-functioning individuals who do not need to fully off-load a lower limb and need rest breaks for cardiopulmonary endurance reasons, but they are the least stable type of walker 2.
- Wheelchairs should be considered for patients who lack the lower body strength, balance, or endurance for ambulation 2.
Considerations for the Patient
Given the patient's poor balance and knee pain, a walker would be a suitable option. However, it is essential to consider the patient's ability to use the device safely and effectively. A two-wheel rolling walker may be more appropriate than a standard walker, as it is more functional and easier to maneuver 2. Additionally, the patient's posture and gait pattern should be taken into account, as leaning-forward posture can lead to a shuffling-like gait pattern and increased risk of falls 3, 4.
Clinical Reasoning and Device Prescription
The clinical reasoning process for prescribing a walking assistive device involves considering multiple factors, including safety, balance, cognition, strength, and function 5. The patient's experience, preferences, and discharge environment should also be taken into account to individualize care and prevent device abandonment 5. Proper sizing and patient education are essential to avoid skin breakdown and ensure safe use of the device 2.