TOPLINE:

Walking aid training provided by physiotherapists in the emergency department (ED) improved mobility and reduced fear of falling in adults aged 65 years or older at 90 days post-discharge, a trial showed. The addition of telemonitoring provided no significant additional benefit compared with walking aid training alone.

METHODOLOGY:

• Researchers conducted a randomized clinical trial at a geriatric ED in São Paulo, Brazil, from July to December 2023, and enrolled 75 participants (mean age, 81.3 years; 53.3% women) who met indications for walking aid use.
• Participants were randomly assigned to three groups: a control group (n = 25) that received verbal instructions and printed guidelines for safe ambulation, a walking aid (WA) group (n = 25) that received a walking aid (cane or walker) plus physiotherapist assessment and hands-on training, and a walking-aids-with-telemonitoring (WAT) group (n = 25) that received the same WA intervention plus twice-weekly video monitoring for 3 months.
• The primary outcomes were an increase in life-space mobility (assessed using the Life Space Assessment Score) and a reduction in fear of falling (evaluated using the Falls Efficacy Scale International) at the 90-day follow-up assessment.
• Secondary outcomes included functional capacity (assessed using the Barthel Index) , gait speed (measured with the Timed Up and Go test), quality of life (assessed using the EuroQoL Five-Dimension, Three-Level Instrument), cognition (evaluated using the 10-point Cognitive Screener), depression (assessed using the 15-item Geriatric Depression Scale), and occurrence of falls.

TAKEAWAY:

• Participants in the WA group showed a significant increase in life-space mobility (mean difference [MD], 12.77; P = .03), a significant reduction in fear of falling (MD, -5.60; P = .002), and a significant increase in repetitions on the 1-minute sit-to-stand test (MD, 8.45; P = .001) compared with those in the control group; however, no significant improvements in any of these outcomes were observed in the WAT vs WA group.
• The participants in the WA group showed improvements in secondary outcomes, including functional capacity (WA vs control: MD, 8.93; P = .007; WA vs WAT: MD, 7.92; P = .02), gait speed (WA vs control: MD, -10.45 sec; P = .02; WA vs WAT: MD, -0.20 sec; P = .97), and cognition (WA vs control: MD, 1.74; P = .03; WA vs WAT; MD, 0.02; P = .97). No significant differences in quality-of-life or depression scores were observed between the groups.
• The number of falls over 90 days was low and similar across groups (three in the WA group, three in the WAT, and four in the control group). All falls were nonserious and not associated with walking aid use.

IN PRACTICE:

"In this randomized clinical trial, provision of walking aids with training by a physiotherapist in the ED improved mobility, fear of falling, gait, functionality, and cognition in older adults at 90 days," the authors wrote. "While telemonitoring did not demonstrate incremental benefit, these findings support the integration of specialized geriatric assessment and intervention in the ED to optimize functional recovery following discharge," they added.

SOURCE:

The study was led by Fernanda Sato Polesel, PT, Hospital Sírio-Libanês, São Paulo, Brazil. It was published online on November 21, 2025, in JAMA Network Open.

LIMITATIONS:

The study was limited by its single-center design and the inability to blind participants due to the obvious nature of the intervention.

DISCLOSURES:

This study was funded by the Advanced Geriatrics Center and Instituto de Ensino e Pesquisa, Hospital Sirio-Libanés. One author reported receiving grant support from the Alzheimer's Association outside the submitted work.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.