@Article{info:doi/10.2196/51898,
author="Wolf, Milan Anton
and Sauerwald, Leon
and Kosmalla, Felix
and Daiber, Florian
and Kr{\"u}ger, Antonio
and Landgraeber, Stefan",
title="Implementation and Evaluation of a Gait Training Assistant for the Use of Crutches: Usability Study",
journal="JMIR Hum Factors",
year="2024",
month="Aug",
day="16",
volume="11",
pages="e51898",
keywords="telerehabilitation; orthopedics; digital gait trainer; orthopedic; gait; movement; walk; walking; crutch; crutches; sensor; sensors; rehabilitation; usability; digital health; physiotherapy; physical therapy; telehealth; telemedicine; eHealth; virtual; locomotor; locomotion",
abstract="Background: Surgical procedures on the lower extremities often require weight-bearing on crutches as part of the rehabilitation process. Orthopedic elective procedures enable patients to learn the correct use of crutches in a controlled preoperative setting. Digital assistance systems can safely circumvent a shortage of skilled staff and any contact restrictions that may be necessary. Objective: The usability of a newly developed gait training assistant (GTA) for the use of crutches will be evaluated. An intervention group trained to use crutches by the digital trainer will be compared with a control group trained to use crutches conventionally by a physiotherapist. Methods: As part of the development and implementation of a novel GTA, 14 patients learned to walk with crutches by completing specific exercises while receiving live feedback. Their movements were detected by a depth sensor and evaluated in real time. Specific parameters (step length, synchronous movement, crutch angle, and crutch distance to the feet) were compared with a control group (n=14) trained to use crutches by physiotherapists. The intervention group was also assessed by a physiotherapist. At the end of the study, the patients completed questionnaires to evaluate the usability of the system (Brooke's System Usability Scale score) and patient satisfaction. Results: All patients trained by the novel GTA were able to use crutches correctly. The intervention group showed significantly better values for crutch angle (mean --6.3{\textdegree}, SD 3.5{\textdegree} vs mean --12.4{\textdegree}, SD 4.5{\textdegree}; P<.001) and crutch position (mean 3.3, SD 5.1 cm vs mean --8.5, SD 4.9 cm; P=.02). Both groups reported that they felt confident in the use of crutches, were able to follow the instructions, and enjoyed the training. Even though the majority (12/14, 86{\%}) preferred physical therapy over a purely digital approach, most participants enjoyed using the system (13/14, 93{\%}) and were interested in trying out other digital assistants (11/14, 79{\%}). The usability of the GTA was rated above average by the majority (9/14, 64{\%}) of the patients. Conclusions: The newly designed GTA is a safe method of teaching the use of crutches and is statistically superior to training by a physiotherapist. Even if patients prefer interaction with a physiotherapist over a purely digital approach, digital devices provide a safe and motivating opportunity to learn the essential locomotor skills for rehabilitation. ",
issn="2292-9495",
doi="10.2196/51898",
url="https://humanfactors.jmir.org/2024/1/e51898",
url="https://doi.org/10.2196/51898"
}