Limited evidence of benefits and harms for interventions to improve outdoor mobility for people living with disabilities
The review in brief
The evidence is very uncertain about most benefits and harms of intervention options aimed to improve outdoor mobility for adults with disabilities, both in the short and long term, and it is currently unclear if any intervention options to improve outdoor mobility are effective and safe.
What is this review about?
Around 15% of the global population live with disabilities and participate in fewer activities outside the home and in the community, and commonly also experience a reduced quality of life. Interventions in this review target outdoor mobility aiming to improve the ability to move, travel and manage orientation outside the home and in the community. These interventions can influence the number of activities outside the home, participation and quality of life but may also lead to harm like falls, injuries and hospitalization.
What is the aim of this review?
The review examines the benefits and harms of interventions aimed to improve outdoor mobility for adults living with different disabilities.
What are the main findings of this review?
What studies are included?
A total of 12,894 studies were reviewed. Twenty-two studies that evaluated interventions aiming to improve outdoor mobility compared to interventions that did not aim to improve outdoor mobility were identified. Twelve ongoing studies with upcoming results were also located. Sixteen studies examined interventions where skills aimed to be used in the outdoor environment were trained. Five studies examined physical training aiming to improve the capacity to move around in outdoor environments, such as treadmill walking. No studies were identified for other types of interventions, such as educational or cognitive behavioural interventions. Most interventions were delivered to people after stroke (13 studies) and older adults living with disabilities (five studies) and were delivered mainly in high income countries.
What are the benefits and harms of skill training?
The evidence is uncertain about the benefits and harms of skill training for all people living with disabilities, both in the shorter and longer term for the possibility to be active outside the home, participation, quality of life and for minor and major harms.
Skill training may improve engagement in everyday life activities in people living with disabilities in the shorter term, but we are uncertain in the longer term. Skill training may improve both activity outside the home and health-related quality of life for people living with cognitive impairments in the shorter term, but we are uncertain in the longer term.
What are the benefits and harms of physical training?
The evidence is uncertain about the benefits and harms of physical training for all people living with disabilities, both in the shorter and longer term for the possibility to be engaged in everyday life activities, participation, quality of life and for minor and major harms. Physical training may improve activity outside the home in people living with disabilities in the shorter term, but we are uncertain in the longer term.
What are the benefits and harms of different treatment options aimed to improve outdoor mobility?
The evidence is uncertain about any difference for benefits and harms of different outdoor mobility treatment options.
What do the findings of this review mean?
Despite identifying 22 studies, the evidence still remains uncertain about most benefits and harms of treatments to improve outdoor mobility, both in the short- and long term. Furthermore, the reported effects of these interventions were considered either small or trivial, and could be of limited relevance to people living with disabilities. The evidence is currently uncertain if there are interventions that can improve outdoor mobility for people living with disabilities and can improve other important outcomes, while avoiding harms.
Future studies that are using more rigorous study designs and include important measurements of improvement for people living with disabilities are needed to reduce this uncertainty to guide policy decisions, treatment decisions of healthcare providers and carers, and decisions to engage in interventions to improve outdoor mobility for people living with disabilities.
How up-to-date is this review?
The evidence is up to date covering publications until January 2023.