Date of Award

Spring 2024

Document Type


Degree Name

Doctor of Philosophy (PhD)


Rehabilitation Sciences


Kinesiology and Rehabilitation Sciences

Committee Director

Julie M. Cavallario

Committee Member

Daniel M. Russell

Committee Member

Mariana Szklo-Coxe

Committee Member

Lisa Koperna


Statement of the problem: Walking adaptive devices (ADs) are commonly used by older adults to increase stability and prevent falls, yet the effectiveness and safety of these devices remain uncertain. This dissertation study investigates the impact of ADs on older adult falls through evidence-based practice concepts of best research evidence, patient values and circumstances, and clinician expertise. Methods: Three distinct studies were conducted, each addressing an essential aspect of EBP. The first study, representing the best research evidence, explored the effect of AD on gait spatiotemporal parameters and motions at the center of mass of twenty-five healthy participants. The second study, representing patient values and circumstances, surveyed 226 healthy older adult participants to examine the method of obtaining ADs (medical professional, private purchase, or second-hand) impact on patient perceptions and self-reported falls. The third study, representing clinical expertise, involved 108 rehabilitative clinicians exploring their preparedness and methods for recommending, assessing, and training patients to use ADs. Results: The study representing the best research evidence concept of EBP demonstrated that ADs alter healthy gait, highlighting decreased gait parameters and restricted center of mass (CoM) motions, which alter the natural biomechanics of gait. The patient value and circumstance study identified the importance of addressing issues related to fitting, training, patient involvement, and ongoing support to enhance the effectiveness of ADs and reduce fall incidence among older adult users. The clinical expertise study delved into the foundational understanding of rehabilitative clinicians' perspectives, indicating a need for improved education and training regarding ADs for older adults, along with standardized testing methods and more precise assessment guidelines to ensure consistent and high-quality care. Conclusion: In summary, the evidence underscores the crucial need for comprehensive research grounded in and incorporating all three concepts of EBP. This research is essential for developing practical guidelines and interventions utilizing walking ADs to address older adult falls. The absence of EBP literature in the AD fall intervention might exacerbate falls among older adults, as the lack of research impedes the evolution of effective interventions.


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