The Impact of Walking Aids and Orthosis on Fatigue and Activities of Daily Living in Knee Osteoarthritis Patients

Abstract

Background: Knee osteoarthritis (KOA) is a prevalent degenerative joint condition that impairs mobility and daily functioning in older adults. While walking aids and orthoses are commonly prescribed to enhance stability, their long-term impact on fatigue and functional independence remains under-investigated, representing a critical gap in conservative KOA management strategies. Objective: To evaluate the impact of walking aids and orthoses on fatigue levels and activities of daily living (ADLs) in individuals with KOA, and to compare functional outcomes across device-user and non-user groups. Methods: A cross-sectional observational study was conducted from January to April 2023 in clinical and residential care settings in Lahore, Pakistan. A total of 156 participants aged 45–85 years with radiologically confirmed Grade 2 or 3 KOA were recruited using convenience sampling. Exclusion criteria included joint replacement, malignancy, and non-ambulatory status. Participants were grouped into non-users, walking aid users, and orthosis users (n=52 each). Fatigue and ADLs were assessed using the Fatigue Severity Scale (FSS) and Barthel Index, respectively. One-way ANOVA and chi-square tests were conducted using SPSS v21, with a significance threshold of p<0.05. Ethical approval was obtained from the institutional review board in accordance with the Declaration of Helsinki. Results: Fatigue prevalence was highest among orthosis users (92.3%) and lowest among non-users (75.0%). ADL independence was greatest in non-users (63.5% slight dependency) and lowest in walking aid users (78.9% moderate dependency). ANOVA showed significant between-group differences in FSS (p=0.012) and Barthel scores (p=0.010), with moderate effect sizes. Conclusion: Use of orthoses and walking aids in KOA patients is associated with significantly higher fatigue and reduced functional independence compared to non-users. These findings suggest that assistive devices should be prescribed with caution and integrated into broader rehabilitative care plans to preserve autonomy in this population.