Walking aids in geriatric rehabilitation as double-edged swords: a Franco-Cameroonian comparative study of contextual factors in long-term functional outcomes

Abstract

Background: Walking aids are fundamental tools in geriatric rehabilitation, yet their prescription and functional impact across different socio-cultural and environmental contexts remain poorly understood. This comparative study examines how contextual factors influence long-term functional outcomes associated with walking aid use in France and Cameroon. Methods: We used a sequential mixed-methods approach combining structured clinical observations in France (2016–2022, n=173 geriatric patients) with a prospective observational study in Cameroon (2022–2025, n=250 patients aged >65 y). Data collection included standardized functional assessments (timed up and go, 6-min walk test, Berg Balance Scale), technical evaluation of walking aids, semi-structured interviews, environmental assessment, and focus groups. Quantitative data were analyzed using SPSS v27, whereas qualitative data underwent grounded theory analysis with triangulation. Results: In Cameroon, 69% of walking aids were self-acquired without professional prescription compared with 12% in France ( P <0.001). After 10 years of use, Cameroonian participants showed significantly lower functional parameters (6MWT: 61% vs. 82% of normative values; TUG: 19.7±4.5s vs. 11.3±2.2s, P <0.001). Multivariate analysis identified 4 factors significantly associated with increased functional dependency: absence of professional prescription (adjusted OR=2.83, 95% CI: 1.96–4.08), lack of prescription reassessment (adjusted OR=2.41, 95% CI: 1.73–3.36), technical non-compliance (adjusted OR=1.94, 95% CI: 1.28–2.93), and environmental barriers (adjusted OR=1.76, 95% CI: 1.19–2.61). Conclusions: This study suggests that walking aids, although designed to enhance autonomy, may be associated with decreased functional independence when prescribed or adopted without consideration of contextual factors. A “Contextualized Prescription” approach integrating biomechanical, environmental, socio-cultural, and evolutionary dimensions shows preliminary promise in adapting walking aid prescription to diverse settings. These findings highlight the importance of considering cultural and environmental factors in rehabilitation practices, although methodological limitations necessitate further controlled studies to validate these observations.