Currently submitted to: JMIR Aging
Date Submitted: Apr 26, 2026
Open Peer Review Period: Apr 27, 2026 - Jun 22, 2026
(currently open for review)
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
A Smart Wheeled Walker With Integrated Physiological Monitoring to Improve Mobility in Older Adults: A Randomized Crossover Trial
ABSTRACT
Background:
Mobility limitations in older adults are associated with increased physiological cost of walking, reduced functional independence, and elevated fall risk. Conventional wheeled walkers improve stability but lack real-time physiological monitoring and safety feedback. Digital health enabled assistive devices integrating physiological monitoring and fall detection may enhance mobility performance and safety.
Objective:
This study aimed to evaluate the effectiveness of a smart wheeled walker equipped with real-time physiological monitoring and fall detection compared with a standard wheeled walker in improving walking efficiency, dynamic balance, and fear of falling among community-dwelling older adults.
Methods:
A single-blind randomized crossover trial was conducted in 30 community-dwelling older adults aged 65–80 years with mild balance impairment (Timed Up and Go >13.5 seconds). Participants completed walking trials using both a standard wheeled walker and a smart wheeled walker in randomized order, with a 30-minute washout period. The smart walker integrated photoplethysmography based heart rate monitoring, pulse oximetry (SpO₂), and a tilt-based fall detection system with mobile alert functionality. The primary outcome was walking efficiency assessed using the Physiological Cost Index (PCI). Secondary outcomes included dynamic balance (Expanded Timed Up and Go) and fear of falling (Falls Efficacy Scale-International). Statistical analysis was performed using paired comparisons with a significance level of p < 0.05.
Results:
Walking speed was significantly higher with the smart wheeled walker (p < 0.01), indicating a large effect. The Physiological Cost Index was significantly lower in the smart walker condition (p = 0.017), reflecting reduced physiological cost of walking. Dynamic balance improved significantly, as shown by reduced Timed Up and Go duration (p = 0.048). Fear of falling showed a small, non-significant reduction (p = 0.624). The integrated physiological monitoring system demonstrated stable signal acquisition during walking.
Conclusions:
A smart wheeled walker integrating real-time physiological monitoring and fall detection significantly improved walking efficiency and dynamic balance in older adults. These findings support the potential of digital health–enabled assistive technologies to enhance functional mobility and promote safe and independent aging. Clinical Trial: Thai Clinical Trials Registry TCTR20250302008.
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