Exploring the Influence of a Novel Application for Training and Evaluating Walking Implementation of an App-based Walking Aid Skills Training Program Aid Skills in Walking Aid Users: A Protocol for a Pragmatic Single-blind Randomized Controlled Trial

This study is a single-masked 2-centre randomized control trial. In order to evaluate the usability and feasibility of the app, we will evaluate 52 (26 female) patients and their physical therapists. Participants will be randomly assigned to either the experimental or control group, both of which will use apps available from Move Improve®. Through the Move Improve® platform, both groups will be shown instructional videos of different movement skills, and then will be able to record secure videos of themselves performing the skills. The control group will watch videos related to breathing skills and the treatment group will watch videos related to walking aids. Patients must be aged 18-80 years and require the regular (>75% of ambulatory time) use of a WA. Patients will be recruited from the South Health Campus Neuromuscular and Orthopedic Clinics, Foothills Medical Centre Orthopedic Surgery and Physiatry Clinics, Foothills Medical Centre Orthopedic Inpatients Units, Foothills Medical Centre Day Surgery Units, University of Calgary Sports Medicine Centre, Momentum Health Physiotherapy Clinics (all in Calgary, Alberta), and Centre interdisciplinaire de recherche en réadaptation et intégration sociale (CIRRIS, in Québec City, Québec) where they will be informed of the project during clinical sessions with their practitioners. Potential patient participants will be screened in-person by a Research Assistant to determine their eligibility.

The primary outcome of the study is the Activities-specific Balance Confidence (ABC) scale assessed at baseline and 4 weeks. Secondary outcomes include the following at baseline and 4 weeks: Timed Up and Go (TUG), 6-Minute Walk Test (6MWT), Berg Balance Score (BBS), Walking Aid Skills Test© (WAST©), number of falls, and a description of upper limb location and pain. Additionally, we will consider both the patient and clinician participant's perspectives about the perceived usefulness, ease of use of, and satisfaction with the app and will ask them about perceived treatment effect and additional time required during therapy sessions. Participant's time spent on and score of each component will also be recorded.

Eligible participants will sign consent forms to participate. During their usual physical therapy session, the patient will use the app on 2 occasions (up to 15 minutes). After the session, the patient will each be asked to complete online questionnaires via Qualtrics (Utah, USA) on the iPad. The questionnaires will include confidence using walking aid, comfort using walking aid, Activity-specific Balance Confidence (ABC) Scale, app ease of use, app usability, and app satisfaction. The Research Assistant will be available during the session in case problems arise.

A physical assessment will occur at baseline, 2-weeks, and 4-weeks after initial assessment. The physical assessment contains the BBS, 6MWT, and WAST©. This evaluation will be conducted by the Research Assistant.

The WAST© will be video recorded by the Research Assistant. We will ask physical therapists to rate the videos of the participants to determine the reliability and validity of the walking aid skills test.