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Walking

Definition

Walking is defined as ‘to move at a regular pace by lifting and setting down each foot in turn, never having both feet off the ground at once’ (Oxford Dictionaries [95]).

Related theory

There are a variety of different walking aids designed to improve balance and safety, thus reducing the risk of falls. These should be assessed for by the physiotherapist, who will provide equipment as appropriate.

It is assumed that, if possible, the patient will take equal amounts of bodyweight through both legs, defined as being fully weight bearing (FWB). If the patient has to be non‐weight bearing (NWB) or partially weight bearing (PWB), this will be due to bone or joint pathology – for example, fracture, joint instability, inflammation or infection.

If a patient has any difficulty walking, appears unsafe or is at risk of falling for any reason, refer them for a physiotherapy assessment. The physiotherapist will assess and issue the patient with an appropriate walking aid and provide appropriate advice.

Evidence‐based approaches

Rationale

Indications

Patient should be encouraged to walk as soon as is safe and appropriate for their condition. This will promote their safety and independence, ensuring they return to their previous routine as soon as possible.

Contraindications

Certain surgical procedures or injuries may restrict a patient's ability to walk, or walking may be detrimental to their recovery for a period of time. Effective weight bearing and therefore walking may also be affected by pain, weakness and sensory changes, and may be contraindicated, especially without assistance or rehabilitation.

Procedure guideline 7.7

Assisting a patient to walk

Table 7.2 Prevention and resolution (Procedure guidelines 7.1, 7.2, 7.3, 7.4, 7.5, 7.6 and 7.7)

Problem	Cause	Prevention	Action
Increase in pain	Change in posture and position of joints and soft tissues. Patients who are symptom‐controlled at rest may suffer incidental pain when moving.	Pre‐procedural symptom control. Ongoing assessment of symptoms and adjustment of medication.	Assist the patient to move slowly and offer support and reassurance where needed.
Increase in nausea	Change in posture and position of joints and soft tissues. Patients who are symptom‐controlled at rest may suffer incidental nausea when moving.	Pre‐procedural symptom control. Ongoing assessment of symptoms and adjustment of medication.	Assist the patient to move slowly and offer support and reassurance where needed.
Change in clinical condition	Change in position may cause a drop in blood pressure or cause cardiovascular instability.	Monitor carefully.	Always have two people present if the patient is at risk of cardiovascular instability. Be prepared to return to the original position.
Bowel or bladder elimination	Change in position may stimulate bladder and bowels.	Have a commode nearby, or the ability to get the patient to the toilet should they need it. If the patient is incontinent, put pads and pants on the patient before moving.	It may be necessary to allow the patient to pass urine or open their bowels before continuing to move or position them.
Increase in loss of fluid, e.g. from a wound	Change in position may cause breakdown of primary healing or increase in muscular activity, which may increase fluid loss.	Give support to wounds during movement where possible. Seek advice from surgical teams prior to mobilizing.	Stop and alert the medical team for assessment.
Loss of consciousness, fainting	Change in position may cause a decrease in blood pressure.	Allow adequate time for the patient to adjust to a more upright position. Sit the patient up in bed and then sit them over the edge of the bed and allow time for positional adjustment in blood pressure before they attempt to stand.	Call for help and follow the emergency procedure. Refer to local procedure for managing a falling patient.
Fall	Multifactorial.	Risk assessment and planning.	Call for help and follow the emergency procedure. Refer to local procedure for managing a falling patient.
Poor adherence to or toleration of sitting position	Discomfort, reduced tolerance or cognitive issues.	Use pillows and/or towels to ensure the patient is well supported and comfortable. A timed goal often helps with patient compliance. Start with a short time, for example 30 minutes, and build up the time slowly. Always tell the patient how long they are aiming to sit out for and make sure the call bell is within reach.	Combine sitting out with a mealtime as this can help the patient to eat more easily and also help to distract the patient from the length of time they have to sit out.
Inability to maintain the position	Patients who are weak and/or fatigued may be at risk of slipping or falling.	Careful positioning of towels and pillows may be needed to maintain a central, safe posture in the chair.	Observe the patient regularly.