Did Your Patient’s Cane Kill Them?

 Did your competent? doctor and therapists get you walking safely without a cane before discharge? NO? 

So, they completely fucking FAILED AT THEIR JOB?

Did Your Patient’s Cane Kill Them?

Mobility assistance devices may be harmful if not prescribed properly

A 74-year-old falls while using a walker. Rather than being a protective factor, the walker could be the culprit in this mishap. Surprisingly, nearly half of all the problems associated with "mobility assistance devices" (MADs) -- products used by approximately one in six older adults -- are related to their difficult-to-use and dangerous nature.

A Commodity or a Medical Device?

The vast majority of older adults using these devices purchase them online from commercial retailers. These sites often advertise hundreds of unvetted, undifferentiated, and under-studied MADs, typically without competent medical advice. To make matters worse, direct-to-consumer marketing of health-related products has exploded in popularity. The majority (58%) of older adults search the Internet for health information. A common behavior is to check online ratings of doctors, hospitals, and devices.

Older adults apply the same techniques when buying MADs, but the trouble is that these devices are pitched to the public as a commodity -- not a medical device. The commercialization of MADs, linked to the habituation to online buying, tends to decrease caution in assessing these products.

Case Study: An Online Search for "Canes and Walkers"

MADs have a massive commercial presence. To put this to the test, we searched one of the largest e-commerce retailers for "mobility assisting walkers" and retrieved more than 160 individual listings -- without guidance, comparative ratings, or advice to consult an experienced professional before purchase. A similar number of canes and walking sticks were showcased. How can a consumer be expected to make the right decision?

"Choice overload" describes a type of decision paralysis in which people have trouble making decisions because of too many options. Providing extensive possibilities can increase the likelihood of making no choice at all.

If an older adult is able to overcome choice overload and purchase a MAD, their use of these devices is often inconsistent. One report canvassing 262 MAD users who had experienced a fall found that 75% of them were not using their device at the time of the fall because "it was unnecessary, inaccessible, inconvenient or made me feel old."

Another study surveying 145 individuals with diverse disabilities found that participants who reported feeling inadequately informed or overwhelmed during the pre-purchase process for assistive technology demonstrated lower satisfaction and were more likely to discontinue device use. Streamlining the range of available products may reduce choice overload and, in turn, enhance both adoption and sustained use of MADs.

Is the Consumer at Fault for Product Misuse?

From our search, we discovered that few commercial websites recommend consulting a physician or other relevant healthcare professional prior to purchase. Warnings are typically absent or buried in fine print. Even if the consumer is willing to read the specifications, accurate advice is difficult to understand for even the highly literate and often incomplete in a marketplace beset by aggressive sales techniques. Omission or minimization of risks, overstatements and misrepresentation of benefits, and underreporting or no mention of product limitations flood the MAD market.

This gap leaves consumers undereducated, vulnerable to product misuse, and prone to injury due to the lack of attention and medical training dedicated to advertising and selling these devices.

Are Manufacturers at Fault?

The FDA rates canes and walkers as Class I devices, requiring them to satisfy baseline requirements that demonstrate acceptable assurance of safety and efficacy -- similar to a legal, existing generic type of device. However, pre-marketing vetting for safety and effectiveness at this class is minimal. A Class II device, for comparison, includes battery-powered wheelchairs, which are subject to rigorous performance guidelines. A Class I rating permits MADs to enter the consumer market with minimal regulatory oversight, effectively shifting the burden of product testing from manufacturers to consumers.

Toward Safer MADs

MADs can be dangerous. Commercialization, choice overload, limited consumer education, and the minimal guidelines regulating MADs can harm their users and contribute to dangerous health outcomes. Improved strategies are needed to promote proper selection, increase the rate and sophistication of training on device use, and incorporate home or office safety evaluations so that older adults may use these devices safely for their intended purpose: to improve their day-to-day lives.