OTA 2001 Posters

The Development of a Hands-Free Crutch: A Pilot Comparison of the Hands-Free Crutch versus Standard Axillary Crutches

Dion Maxwell, RT; Allan Dalton, RT; Cornelia M. Borkhoff, MSc; Amik Nagpurkar; Kelly P. Fallon; Hans J. Kreder, MD, Sunnybrook & Women's College Health Sciences Centre, Toronto, ON, Canada

Purpose: We report on our pilot comparisons of a newly developed hands-free crutch (HFC) with standard axillary crutches (SAC) with respect to patient acceptability, comfort, function, and safety.

Methods: A new device was developed that allows hands-free walking while being non-weight bearing for a unilateral below-knee injury. Non-weight bearing is accomplished with the new device secured to the upper thigh with weightbearing through a flexed knee on a platform. We used a crossover design with six patients who came to the fracture clinic with lower extremity foot and/or ankle injuries. They were randomly assigned to two-weeks of using one type of crutch followed by two-weeks of the other type of crutch. Function was measured after both time periods with use of the MFA and SF-36 questionnaires. In addition, we elicited information regarding patient acceptability, comfort, and feelings of safety. Data analysis was undertaken using paired non-parametric statistical tests (WSR and sign test). The design of this pilot study was recently repeated in El Salvador with 23 patients who had either an acute lower limb fracture or a below-knee amputation to investigate the feasibility of using the HFC within a developing country. Additional pilot study included comparison in three subjects of the total mechanical energy expenditure with use of the HFC and with use of the SAC with that of normal walking.

Results: The age of the subjects ranged from 17 to 45 years (mean, 31 years). All patients found the HFC easy to learn and to use. All found the HFC easy to walk with, while three of six subjects found walking with SAC difficult, although the small sample size precluded reaching statistical significance (P = 0.08). Similarly, activities of daily living were easier to accomplish with the HFC (P = 0.07). None of the patients found the HFC to be uncomfortable, whereas two of six found the SAC to be uncomfortable. Only one patient preferred the SAC overall. The HFC was associated with a better overall MFA score (P <0.05), better coping (P <0.05), and a trend toward better lower extremity function and activities around the house (P = 0.07). SF-36 physical function tended to be better with the HFC (P = 0.08) in addition to SF-36 vitality (P = 0.07). Preliminary results suggest that the mechanical energy expenditure when using the HFC is closer to that of normal walking than is the swing-through gait with the SAC. The pilot study in El Salvador involved 23 patients (14 men and 9 women) who had either an acute lower limb fracture (n = 13) or a below-knee amputation (n = 10). These patients lived in both rural (n = 16) and urban (n = 7) locations and included a wide age range (20 to 70 years, mean, 40.8). Qualitative and quantitative data examining function and reasons for acceptance or rejection of the HFC compared with the SAC for use in this population will be presented.

Conclusion: The HFC was well-accepted, safe, and easy to use. There was a clear trend toward better function with the HFC. With this new device, patients who need to be non-weight bearing due to pathologic conditions below the knee now have the ability to maintain use of their upper extremities with the HFC.