Preprint · Jan 2026
How Do Walking Aids Affect Gait and Fall Risk in Older Adults? A Systematic Review of Biomechanical and Clinical Determinants
By DHARMANSYAH D
Background: Falls are the leading cause of injury-related morbidity and mortality among older adults. Walking aids — including standard walkers, wheeled walkers (rollators), canes, and crutches — are commonly prescribed to enhance stability and prevent falls. However, paradoxically, walking aid users continue to experience high fall incidence, and the biomechanical and clinical determinants underlying gait abnormalities and fall risk in this population remain unclear. Objective: This systematic review aims to synthesize and critically appraise the existing evidence on how walking aids affect gait parameters (spatiotemporal, kinematic, and kinetic) and fall risk among older adults (aged ≥60 years). Specifically, it seeks to identify the biomechanical and clinical determinants — including device type, user characteristics, environmental factors, and training status — that contribute to gait abnormalities and elevated fall risk in walking aid users. Methods: A systematic literature search will be conducted across four electronic databases: PubMed, Scopus, Web of Science, and IEEE Xplore. The review will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. Two independent reviewers will screen titles, abstracts, and full texts against predefined eligibility criteria. Data extraction will capture study characteristics, population demographics, walking aid type, gait parameters, fall outcomes, and identified determinants. Risk of bias will be assessed using validated tools appropriate to each study design. A narrative synthesis will be performed, with meta-analysis conducted if sufficient homogeneity exists among included studies. Expected Outcomes: This review is expected to provide a comprehensive mapping of biomechanical and clinical determinants of gait abnormalities and fall risk specific to walking aid users. Findings will inform evidence-based recommendations for walking aid prescription, user training protocols, and fall prevention strategies in clinical geriatric practice. The results are intended for submission to Aging Clinical and Experimental Research (Springer).