For people living with fatigue, pain, and breathlessness, everyday movement can be difficult. Mobility aids, like rollators and walking frames, can help people stay independent, safe, and maintain well-being.

Matthew Maddocks, a Professor at the Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care (NMPC), is leading a project to change this. "There’s not a lot of understanding about how these aids meet the needs of people with advanced illness", he explains. "Much of the existing research focuses on adults as they age or people recovering from surgery."

For people with mobility challenges caused by advanced illness, rollators can be a vital source of support. The right design can enhance safety, comfort and ease of movement. However, when the design fails to meet an individual’s needs, the equipment can become more of a burden than a benefit and may even be unsafe.

Putting lived experience at the centre

The project brings together the Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care (NMPC) and the Faculty of Natural, Mathematical & Engineering Sciences (NMES). This cross-disciplinary work combines a scoping review with in-depth interviews to identify design improvements with potential users.

One participant in the project’s interviews was excited to use a new rollator. They imagined it would help them get around their home and neighbourhood easily. Instead, it quickly became a source of frustration.

Engineers from the Faculty of Natural, Mathematical & Engineering Sciences (NMES) are looking at the problems faced by people using devices that are currently on the market and the best innovations available. This will help them make design briefs and develop better products for patients.

Members of the team went to NAIDEX, the UK’s top event for disability and independent living. They found several leading models but “none that fully addressed the combination of needs people in our interviews described.” Now, with the London Institute for Healthcare Engineering, they are running joint design workshops to explore small changes that can improve frames, brakes, and folding for storage.

Fixing the system around the product

Design alone is not enough. Professor Maddocks stresses that even the best rollator will not help people if the system to support it is faulty: "We’ve met people with equipment that doesn’t work for them anymore. They feel stuck because there’s no way to review or exchange it," he explains. 

Currently the support someone gets often depends on their location. There is no standard way to reassess or replace assistive devices when a person’s needs change.

Some study participants received a rollator years ago. However, no one reached out to see if it still met their needs. People in small flats or houses found it hard to store and move around with bulky frames. As a result, devices were left unused. This wasted valuable resources and left others waiting for access.

The team points to system like in Ontario, Canada, as a model of best practice. Mobility aids are checked often and repaired for reuse when they're no longer needed. The system works closely with clinical and rehabilitation teams. This way, mobility support becomes an integral part of a person’s care plan. “It’s a responsive system that adapts to the person, rather than expecting the person to adapt to the system”.

Policy impact and global partnerships

Alongside academic research, the team is also engaged in global advocacy. They are collaborating with the World Health Organization and ATscale, a UN hosted partnership. Their goal is to raise awareness of assistive technologies in palliative care.

A new WHO policy brief from the team will help policymakers. It uses their findings to show why and how to add assistive technologies to care systems. "People often view these technologies as ‘extras,’ but they are crucial for people’s dignity, independence, and wellbeing", says Professor Maddocks.

What's next?

This research will contribute to a design brief for a walking aid design.

They will aim to produce:

• Further publications about assistive devices that use technology to aid mobility. They cover the barriers and support for using these devices in advanced illness.
• A design brief for the production and testing of novel assistive devices fit for the future. 

This project is backed by the Better Health & Care Hub at King’s College London. It unites physiotherapists, engineers, and global health experts. Together, they create solutions that are simple, scalable and focused on the patient.