Patient Preference and Physical Demand for Hands-Free Single Crutch vs Standard Axillary Crutches in Foot and Ankle Patients

Abstract

Background: Weightbearing restrictions following foot and ankle surgery require the use of appropriate assistive devices for nonweightbearing ambulation during the recovery period. Selecting an appropriate assistive device that safely optimizes mobility and participation in daily activities is important to patient compliance and satisfaction. The purpose of this study was to compare physiologic demand, perceived exertion, and patient preference between a hands-free single crutch (HFSC) and standard axillary crutches (SACs) in foot and ankle patients. Methods: Using 44 preoperative orthopedic foot and ankle patients who had a mean age of 32 (19-51) years, a prospective, randomized, crossover study was performed. The sample consisted of 35 males and 9 females. The mean body mass index (BMI) was 26 (19-36), the mean height was 1.7 m, and the mean weight was 82 kg. Patient data and preactivity heart rate were recorded for all patients, who were then randomized to either an HFSC or SACs. Each patient was randomly assigned to the device they would utilize first using a random number generator. They then crossed over to the other device after vitals returned to within 10% of their baseline heart rate. Every subject completed a 6-minute walk test (6MWT) using both assistive devices in a crossover manner. Immediately following each 6MWT, postactivity heart rate, self-selected walking velocity (SSWV), perceived exertion using the OMNI Rating of Perceived Exertion (OMNI-RPE), and perceived dyspnea using the Modified Borg Dyspnea Scale were obtained. After completing both 6MWTs, patients were asked which assistive device they preferred the most. Results: The HFSC was preferred by 86% of patients. Significantly lower dyspnea scores (2.8 vs 5.3; P < .001), fatigue scores (2.4 vs 5.5; P < .001), preactivity and postactivity change in heart rate (28 vs 46 bpm; P < .001), and mean postactivity heart rate (107 vs 122 bpm; P < .001) were found using the HFSC compared with the SACs. The SAC group trended toward a higher SSWV (0.8 vs 0.77 m/s; P = .08). Those with a BMI greater than 25 also preferred iWALK over SACs ( P < .05). Neither group had any falls. Sixty-eight percent of patients complained of axillary/hand pain with the SACs, while 7% complained of proximal leg strap discomfort with the HFSC. Conclusion: The results of the current study in our relatively healthy cohort found that foot and ankle patients who were nonweightbearing preferred the HFSC over SACs. They experienced less physiologic demand as well as discomfort and perceived less exertion when using the HFSC compared with SACs. Level of Evidence: Level II, prospective comparative study.

Comparison of Lower Extremity EMG Muscle Testing With Hands-Free Single Crutch vs Standard Axillary Crutches

“…One other study has been done on this device, noting that participants showed increased levels of preference for the HFSC over SAC due to decreased levels of perceived exertion and discomfort. 23 Though this study has shown that the HFSC increases muscle activity while in nonweightbearing conditions, it is limited in correlating this result to decreased levels of atrophy and faster recovery timelines. Increased load on and activity of a muscle is known to lead to decreased atrophy, but many other factors affect the strength of a patient's muscles while recovering from an injury, including nutrition, compliance, and overall healing.…”

“…One other study has been done on this device, noting that participants showed increased levels of preference for the HFSC over SAC due to decreased levels of perceived exertion and discomfort. 23…”

“…2,14 Though SAC provide benefits to their users, they also have negative impacts including requiring twice as much energy as walking to ambulate, restricted ambulation as both arms must be used for locomotion, and can cause injuries such as brachial plexus compressive neuropathy. 10,23,24,26,32 Additionally, SAC use can result in muscle atrophy and decreased blood flow. 11,27 SAC require the restricted limb to be held in a static fixed position while the contralateral extremity provides forward propulsion.…”

“…2,14 Though SAC provide benefits to their users, they also have negative impacts including requiring twice as much energy as walking to ambulate, restricted ambulation as both arms must be used for locomotion, and can cause injuries such as brachial plexus compressive neuropathy. 10,23,24,26,32…”

“…One type of HFSC is the iWALKFree (iWALKFree, Mansfield, Ontario, Canada) and a recent study found that patients prefer the iWALKFree when compared to SAC because of decreased levels of perceived exertion and discomfort. 23 This item is widely available in retail stores and on the Internet without the need of a prescription. This HFSC operates by resting the injured area horizontally on a knee plate, while the knee and upper area of the leg support the user's body weight during the gait cycle ( Figure 1).…”