Perceptions of individuals with stroke regarding the use of a cane for walking: A qualitative study

Abstract

It is well known that clinical decisions, which include prescription of canes after stroke, should not only be based on biomechanical research. According to the principles of evidence-based medicine, patients' perceptions and preferences should also be investigated to help planning good clinical decisions. The purpose of this study was to comprehend how ambulatory people with stroke, naïve to the use of canes, perceive using a cane during walking. An exploratory, qualitative study was conducted. Twenty-four people, on average 6 years after a stroke, were included. Participants were categorized as slow (<0.4 m/s), intermediate (0.4–0.8 m/s), or fast walkers (>0.8 m/s), based on their baseline walking speed. Participants' spontaneous perceptions regarding the use of a cane were collected during a timed-walk test and analyzed, following standardized recommendations. The discourse of each participant was categorized into “positive perceptions” or “negative perceptions”. Overall, the nature of the perceptions was both positive (i.e., improvements of mobility and/or independence, and improvement of safety/balance and/or reduced risk of falls) and negative (i.e., social stigmatisms, and interference with use of the non-paretic upper limb). However, participants’ perceptions were diverse, depending on their walking ability. Participants categorized as slow walkers perceived the use of a cane as positive, but this positive perception decreased, as walking ability increased. The most positive perceptions came from individuals with severe and moderate walking limitations, who tended to believe that using a cane may be helpful for improving walking, safety, and promoting independence. Fast walkers provided negative perceptions, and may not choose to use canes for walking due to social stigmatisms or interference with use of the non-paretic upper limb.