Axillary superior to forearm crutches in terms of gait, walking speed, stability

Axillary crutches provide superior crutch gait, walking speed, and stability, while requiring less effort to use, as compared with forearm crutches, according to a recent Singapore study.

“The relevance of this study is to better guide patients for rehabilitation options, as well as to provide institutional cost savings. The results from the different [assessments] show that axillary crutches are superior to forearm crutches,” the researchers said.

Twenty healthy volunteers (aged 40–80 years; 11 men) participated in the study; all participants were independent in their activities of daily living and none had had previous experience with crutches. Axillary crutches were compared with forearm crutches through assessments conducted over four stations: straight line single-leg ambulation over 20 m (station 1), timed-up-and-go test (station 2), computerized dynamic posturography (station 3), and a subjective preference questionnaire (station 4).

In station 1, the mean time to complete 20 m of straight-line ambulation was 51.62±27.55 and 59.39±35.62 s for the axillary and forearm crutches, respectively. This corresponded to a significant difference of about 8 s in favour of axillary crutches (p=0.04). Walking speed was also significantly faster when using axillary crutches (0.5 vs 0.44 m/s; p=0.02). [Malays Orthop J 2021;15:36-42]

Similarly, the axillary crutches led to a significantly faster completion time for the timed-up-and-go circuit in station 2 vs forearm crutches (63.06±19.23 vs 75.36±25.34 s; p<0.001).

The computerized dynamic posturography in station 3 was performed to compare the dynamic postural stability between the two crutches. While standing on a dual-force plate platform with a crutch, participants were subjected to the adaptation test, which required them to maintain their balance as the platform tilts forward and backward.

During the 5° backward tilt, the mean effort scores obtained for the axillary and forearm crutches were 39.13 and 42.03, respectively (p=0.0497). This score difference of 2.9 points translated to a 6.9-percent increase in effort to maintain balance when using the forearm vs axillary crutch.

Similar results were found during the 5° forward tilt, with the axillary crutch yielding a marginally lower effort score (31.44±5.75 vs 32.15±5.48; p=0.505). Though not significant, such a trend still suggested that axillary crutches were more stable.

In the subjective questionnaires, 80 percent of participants said they preferred axillary crutches over the forearm crutches, while 90 percent agreed that the former was superior, especially in terms of ambulation and balance/stability. Moreover, 65 percent of patients also felt that axillary crutches required less energy to use. In contrast, 60 percent preferred the aesthetics of forearm crutches.

“The primary aim of the study was to directly compare two types of crutches, hence we avoided [individuals] with limb injuries as the varying levels of limb disability amongst [participants] may introduce large confounders and variability in outcomes,” the researchers said.

“It would be helpful to expand upon this study to evaluate the effect of different types of crutches on patients with specific limb disabilities,” they added.