Ambulatory individuals with spinal cord injury using walking aids generally do not report better long-term outcomes than wheelchair users: results from the InSCI-NL survey.
Marthe C G Langerwerf, Karin Postma, Janneke Stolwijk-Swuste and 5 others
People with spinal cord injury who walk with aids did not report better participation, employment, health, or quality of life than manual wheelchair users.
Their only advantage was in self-care and bladder and bowel independence.
Key findings
1People walking with a frame, crutches, or cane did not report better participation, employment, physical activity, environmental barriers, secondary health conditions, general health, vitality, mental health, or quality of life than manual wheelchair users. Their only advantage was in self-care and bladder and bowel independence.
2Electric wheelchair users reported the worst outcomes on functional independence, participation problems, and secondary health conditions compared with manual wheelchair users, but no differences on paid work, physical activity, environmental barriers, general health, vitality, mental health, or quality of life.
3Physical inactivity was high in every mobility group, ranging from 74% of electric wheelchair users to 32% of ambulatory individuals without walking aids reporting zero minutes of activity per week.
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What it does not show
The subgroups were small (42 to 90 per group), and the authors note that power may have been insufficient to detect real differences between groups. The Bonferroni correction for six pairwise comparisons lowered the significance threshold to p < 0.0083, which further reduced the chance of finding a difference given the small subgroup sizes. Mobility level was measured by how a person moves over 10 to 100 metres, not by how they actually get around in daily life. In the walking-aid group in particular, there may have been wide variation in real-world mobility. The survey did not ask how much effort or pain walking required, which the authors identify as a potential determinant of outcomes in the ambulatory group. All outcomes were self-reported, and the authors note that people with more independent mobility may rate themselves differently, for example by comparing themselves to people without a disability. Single country, single time point, and a 30.7% response rate mean the findings may not generalise beyond community-living Dutch adults with spinal cord injury.
Declared interests
The authors declared no conflicts of interest. No funding source is named in the paper.
The easy way to misread this
Do not read the null finding as proof that walking aids are useless or that wheelchair training should replace ambulation. The subgroups were small (57 walking with aids, 90 manual wheelchair), the Bonferroni correction reduced the chance of detecting a real difference, and the study did not measure the effort, pain, or personal value of walking. This is a one-time snapshot of self-reported outcomes in one country, not a test of what a treatment programme achieves over time.
Summarised by AI from the full paper, without a clinician reviewing it. Check it against the source before it changes what you do. Read it on PubMed →