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software, and maximum anterior excursion of the centre ofpressure was determined for each trial. Mean values foreach condition in individual subjects were used to compareconditions using analysis of variance.

Results The maximum forward excursion of the CoP wassequentially increased through control, soft collar and hardcollar conditions. Mean maximum anterior position of CoPand 222.19 mm hard, 218.16 mm soft, 216.39 mm controlcollar. A significant difference was found (p < 0.05), andpost hoc testing identified significant differences betweenhard and soft collars, and the hard collar and no collarconditions.

No significant difference was found between no collarand soft collar conditions.

Discussion As movement of the neck was progressivelyrestricted, the strategy for StS was altered, with the bodyinitiating more forward movement during performance ofthe task. By limiting neck movement anterior displacementof the CoP was increased, potentially making the subjectless stable. Increased forward momentum is an importantelement in the efficiency of the StS task. Slowing of StS isknown to occur with ageing and the total muscle effortrequired is consequently increased. Current evidenceidentifies falls in elderly people occurring in transitionbetween sitting and standing, and wearing of a collar mayfurther compromise safety in these individuals. Furtherevaluation of the effects of collars on centres of pressure inrepresentative groups may identify strategies to minimiserisk.

Energy Expenditure duringNon-weight-bearing WalkingUsing Elbow Crutches

R Mullis, R M Dent, R Hopkins, M A Hughes, B Hollins, J WaterfieldKeele UniversityIntroduction Walking aids are commonly prescribed whennormal ambulation is compromised. Many authors havedocumented specific guidelines describing the optimallength of walking aids for individual patients, but these tendto be based primarily upon subjective assessments of gaitquality, as opposed to considerations of the energy demandor biomechanical efficiency of walking. The aim of thisstudy was to investigate the effect of elbow crutch length onenergy cost in three-point non-weight-bearing (NWB)walking.

Method A convenience sample of 41 healthy subjects wasselected from university students and staff. They walkedaround an outdoor track using a three-point NWB gait withelbow crutches set to length using conventional guidelines,and either 2.5 cm or 5 cm above and below this value.Oxygen consumption, carbon dioxide production, heart

rate, speed of walking and perceived exertion under steady-state conditions were measured.

Results The energy cost (in terms of oxygen consumption)of walking with crutches set to length using conven-tional guidelines was not significantly different from thatmeasured when using crutches set at 2.5 cm above or belowthis value or at 5 cm below this value. There was asignificant increase in energy cost when using crutches set 5 cm longer than suggested in conventional guidelines.Similarly, significant increases in heart rate and perceivedexertion occurred when using crutches set 5 cm longerthan conventional guidelines dictate, but not under theother tested conditions.

Speed of walking was not significantly affected by crutchlength.

Conclusion Exact crutch length was not critical in terms of energy cost, heart rate, perceived exertion or speed of walking. Therefore the importance of rigidly adhering to specific guidelines for setting crutch length was not substantiated. Clinically, consideration of patientpreference regarding crutch length (within ± 2.5 cm ofconventional guidelines) can be advocated, before anysignificant impact of energy efficiency occurs.

Why Do Elderly People UseWalking Aids?

J SimpsonSt George’s Hospital Medical School, London

B RichardsonUniversity of East AngliaObjective To find out why elderly people use walking aids.

Methods Clinicians preparing to take a post-registrationuniversity course in elder rehabilitation collected the data

as a pre-course exercise. Each clinician received a detailedprotocol and interview schedule. The target was to inter-view ten people over 65 years old who used any form ofwalking aid and who could co-operate and give validanswers. In order to yield systematic, consecutive samplesthey were to consider all such patients referred to theirwork area from a chosen start date. The interview schedulegave detailed guidance on eliciting patients’ own reasonsfor using the device and recording them verbatim. Theywere also asked to judge the validity of their reasons and tocheck the accuracy of any physical or physiological reasongiven. The two authors content analysed and coded theresponses independently, and then together.

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Results Twenty-three students participated (intakes 1997,98, 99) yielding 181 valid data sets: inpatients 58%, dayhospital 36%, domiciliary 18%, residential/nursing home13%, the rest outpatients or accident and emergency.Patients’ mean age was 82 years (SD 7), range 64 to 100.Single sticks were the most common aid 45%; four-pointsupport including wheeled models 43%; the rest used twosticks, two crutches, and a tripod.

According to the patients’ responses and the therapists’opinions the main reasons were pain 11%, justifiablepostural instability 44%, anxiety and lack of confidence32%. Additionally 8% had been told to use an aid and hadnever been re-assessed.

Clinicians’ apparent reluctance to probe led to poverty ofdata and sometimes made interpretation difficult. Otherissues suggested in the data were healthcare professionals’need for collective responsibility to pro-actively reviewpatients’ use of walking aids, and a health promotion needto encourage older people to take professional advicebefore starting to use a walking aid.

Conclusions Many elderly people are using walking aids,frames in particular, when probably they could be trainedto walk independently or with a stick. Clinicians should bevery clear about the reasons why their patients use walkingaids.

Evaluation of Single-handedPractice of Physiotherapistsand PodiatristsS Thornton, N King, P A RenwickHuddersfield UniversityIntroduction The gradual shift of services away fromhospitals into locality-based centres has highlighted theneed for therapists to work alone or in small groups. Thepurpose of this study is to evaluate the current extent ofsingle-handed practice of newly qualified therapists toidentify roles and expectations of supervision.

Method This is a qualitative study to explore issues of single-handed practice and supervision from theperspectives of key stakeholders within local NHS hospitaland community trusts. Subjects were purposely sampled forage, sex, ethnicity, profession and status. Fifty-two semi-structured interviews used a question schedule. Participantswere all interviewed in English with care taken to ensurethat interviewers were not from the same professionalbackground as the interviewees.

Recordings were transcribed verbatim and analysed usingthe Template Analysis technique developed by King (1995).All transcripts were initially read and analysed by all theresearchers to refine the Template prior to final analysis.

Results From preliminary findings it is evident that similarissues regarding single-handed practice and supervision areimportant within both the acute and primary sectors.Emerging issues to date are:

� Variable supervision from informal to formal structures.

� Emphasis of supervision targeted to junior rather thansenior staff.

� Variable definitions of terms and expectations.

� Anxiety regarding the changing role from acute tocommunity sectors.

Discussion From this preliminary study key issues haveemerged regarding the single-handed practice of newlyqualified physiotherapists and podiatrists. Differences inprovision and quality of supervision have been identifiedand the need for a more formalised structure has beendemonstrated with a particular need highlighted in respectof senior staff. It is anticipated that the project will continuein order to define, implement and evaluate a model ofsupervision.

References

Department of Health (1998). The New NHS: Modern,dependable, DoH, London.

King, N (1995). ‘The qualitative research interview’ in:Cassell, C and Symon, G (eds) Qualitative Methods inOrganisational Research, Sage, London.

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