Comprehensive Summary
This single-center randomized clinical trial investigated whether providing walking aids with physiotherapist-led training, with or without telemonitoring, improves various mobility and fall-related outcomes in older adults 90 days after emergency department (ED) discharge. Seventy-five patients were randomized to receive a walking aid alone (WA), a walking aid with telemonitoring follow-up (WAT) or usual care without intervention. Participants in both intervention groups received standardized device-use training from a physiotherapist during the ED visit. The WAT group also completed video-based telemonitoring after discharge. Primary outcomes were mobility and fear of falling at 90 days, assessed by the Life Space Assessment and Falls Efficacy Scale International, respectively. Secondary outcomes included gait, functional capacity, quality of life, cognition, depression, and fall incidence. Compared with usual care, the WA group demonstrated significantly improved mobility, (mean difference [MD]: 12.77, 95% CI: 1.06-24.54), reduced fear of falling (MD: –5.60, 95% CI: –9.06 to –2.14), and greater functional performance on the 1-minute sit-to-stand test (MD: 8.45, 95% CI: 4.34-12.56). No significant difference was observed between WA and WAT groups.
Outcomes and Implications
Mobility impairment is common among older ED patients and is closely linked to fall risk, functional decline, and loss of independence. This study suggests that providing older patients in the ED with walking aids and physiotherapist instruction improves mobility, confidence, and functional performance in the 90 days after discharge, although telemonitoring does not provide additional benefit. While the study is limited by its single-center design and inability to blind participants, these findings support integrating targeted mobility interventions into the geriatric ED setting. Larger, multicenter studies are warranted to confirm these results and increase generalizability across diverse populations and settings.