Functional, Spiroergometric, and Subjective Comparisons Between Forearm Crutches and Hands-Free Single Crutches in a Crossover Study

Daiwei Yao; Louisa Meyer-Kobbe; Sarah Ettinger; Leif Claassen; Anna Altemeier-Sasse; Christian Sturm; Arno Kerling; Christina Stukenborg-Colsman; Christian Plaass

doi:10.1177/24730114231172734

Functional, Spiroergometric, and Subjective Comparisons Between Forearm Crutches and Hands-Free Single Crutches in a Crossover Study

Foot Ankle Orthop. 2023 May 19;8(2):24730114231172734. doi: 10.1177/24730114231172734. eCollection 2023 Apr.

Authors

Daiwei Yao^{1

2}, Louisa Meyer-Kobbe³, Sarah Ettinger^{2

4}, Leif Claassen^{2

5}, Anna Altemeier-Sasse^{2

4}, Christian Sturm⁶, Arno Kerling⁶, Christina Stukenborg-Colsman², Christian Plaass²

Affiliations

¹ ATOS Orthopedic Clinic Braunfels, Braunfels, Germany.
² Department for Foot and Ankle Surgery, DIAKOVERE Annastift, Orthopedic clinic of the Hannover Medical School, Hannover, Germany.
³ Hannover Medical School, Hannover, Germany.
⁴ University Hospital for Orthopedics Pius Hospital Oldenburg, Oldenburg, Germany.
⁵ Orthoprofis Hannover, Hannover, Germany.
⁶ Department for Rehabilitation- and Sports Medicine, Hannover Medical School, Hannover, Germany.

Abstract

Background: Following below-knee surgery, the optimal medical mobility device remains controversial as adequate nonweightbearing of the operated extremity is critical to ensure successful healing. The use of forearm crutches (FACs) is well established but requires using both upper extremities. The hands-free single orthosis (HFSO) is an alternative that spares the upper extremities. This pilot study compared functional, spiroergometric, and subjective parameters between HFSO and FAC.

Methods: Ten healthy (5 females, 5 males) participants were asked to use HFSOs and FACs in a randomized order. Five functional tests were performed: climbing stairs (CS), an L-shaped indoor course (IC), an outdoor course (OC), a 10-meter walk test (10MWT), and a 6-minute walk test (6MWT). Tripping events were counted while performing IC, OC, and 6MWT. Spiroergometric measurements consisted of a 2-step treadmill test with speeds of 1.5 and 2 km/h, each for 3 minutes. Lastly, a VAS questionnaire was completed to collect data regarding comfort, safety, pain, and recommendations.

Results: Significant differences between both aids were observed in CS and IC (HFSO: 29.3 seconds; FAC: 26.1 seconds, P < .03; and HFSO: 33.2 seconds, FAC: 18 seconds, P < .001, respectively). The other functional tests showed no significant differences. The trip events were not significantly different between the use of the 2 aids. Spiroergometric tests showed significant differences regarding heart rate (HFSO: 131.1 bpm at 1.5 km/h and 131 bpm at 2 km/h; FAC: 148.1 bpm at 1.5 km/h and 161.8 bpm at 2 km/h) and oxygen consumption (HFSO: 15.4 mL/min/kg at 1.5 km/h and 16 mL/min/kg at 2 km/h; FAC: 18.3 mL/min/kg at 1.5 km/h and 21.9 mL/min/kg at 2 km/h) at both speeds (all P < .01). In addition, significantly different ratings regarding the items comfort, pain, and recommendation were recorded. Both aids were equally rated for safety.

Conclusion: HFSOs may be an alternative to FACs, especially in activities that require physical stamina. Further prospective studies in patients with below-knee surgical intervention concerning everyday clinical use would be interesting.

Level of evidence: Level IV pilot-study.

Keywords: crutches; hands-free crutch; postoperative care; postoperative nonweightbearing.