Effect of Preoperative Mobility Device Training on Postoperative Fall Incidence

Most of the surgeries involving the foot and ankle require non-weight bearing status post
operatively. Patients use crutches, walker or knee scooters during that period to avoid
weight bearing. However, using any mobility device(s) requires training to avoid falls. Most
of the falls happen during early post-operative period after any surgery [1]. The usage of
assistive mobility device(s) increases the risk of falls [2]. Some studies have shown
physical therapy and training to decrease this risk of falls [3]. Physical training for usage
of assistive devices can be done either preoperatively or post operatively. When training is
done postoperatively, it may increase the risk of fall due to pain, usage of narcotic drugs,
especially in older patients due to lack of muscle power[1,2]. To prevent these increased
risks, the training can be done preoperatively. However, the role of preoperative training
regarding usage of assistive devices has not been emphasized in the literature. Hence, the
aim of our current study is to evaluate the difference between preoperative training and no
training before surgery on the use of mobility device(s).

250 patients will be enrolled in the study. Each participant will be stratified by
randomization into either Group 1 or Group 2. Patients in Group 1 will receive training on
the mobility device(s) during their standard pre-operative care whereas patients in Group 2
will not receive this training. This training is not a component of routine, standard
pre-operative care. Each group will include 125 patients.

Working in conjunction with UAB Foot and Ankle Division of the Orthopaedic department,
volunteers meeting inclusion criteria will be identified in the outpatient clinic setting.
After thorough discussion of risks and benefits, potential volunteers will be consented for
participation in the study. The volunteer's demographic data will be obtained including
gender, age, and race. The patient will then undergo the "pre-operative mobility device(s)
training" during the pre-operative physical therapy visit, if they are randomized to Group 1.
Patients in Group 2 will not receive this training. The preoperative training will not incur
any additional cost to the patient. Patients in both groups will then undergo standard
operative care. During routine 2-week and 6-week follow-up visits, they will be asked
questions from a questionnaire that will assess the number and details of any fall(s) they
may have experienced.

1. Plati C, Lanara V, Mantas J. Risk Factors Responsible for Patients' Falls. Scand J
Caring Sci 1992;6:113-8.

2. Rao SS. Prevention of Falls in Older Patients. Am Fam Physician 2005;72:82-8.

3. Karlsson MK, Magnusson H, Rosengren BE. Prevention of falls in the elderly — a review.
Osteoporos Int 2013;24:747-62. doi:10.1007/s00198-012-2256-7.

Inclusion Criteria: Inclusion criteria is age 18 and older undergoing elective unilateral
foot/ankle surgery requiring a period of post-operative non-weight-bearing or
partial-weight-bearing period - advised by the operating surgeon.

Exclusion Criteria: Exclusion criteria includes patients less than 18 years of age,
wheelchair-bound patients, patients with history of previous use of post-operative mobility
device(s), patients with ankle fractures, patients with previously diagnosed condition(s)
with cognitive, balance, mobility impairment and patients undergoing bilateral surgery,
patients requiring follow ups longer than 6 weeks.