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GaitSmart rehabilitation exercise programme for gait and mobility issues

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2 The technology

Technology

2.1 GaitSmart rehabilitation exercise programme (Dynamic Metrics) is intended for people who are ambulatory or partially ambulatory and have gait and mobility issues. It comprises digital gait assessment and personalised rehabilitation exercises. GaitSmart is a CE marked class 1 medical device that uses sensor-based digital technology to monitor limb movement. Seven sensors are placed 1 on either side of the pelvis, 1 on each thigh and calf, and 1 at the base of the spine. Objective measurements are taken while the person is walking to identify any problems with gait. Information from the sensors is automatically processed to produce a colour-coded report that helps the person and healthcare professional to understand any gait issues and the severity. The test takes 10 minutes to complete and can be done by a healthcare assistant in a variety of settings. The gait assessment produced by GaitSmart is used with an integrated app, vGym. This produces a personalised rehabilitation programme consisting of 6 exercises to help improve mobility. The app provides photos and descriptions of each exercise. The reports and advice provided can also be printed off and used without needing access to a personal device. Once allocated to the GaitSmart programme, each person should have a total of 4 gait assessments, done by a healthcare assistant, every 3 to 6 weeks. Each gait assessment identifies any changes in gait and mobility, and alters the exercises accordingly.

Care pathway

People at risk of falls

2.2 NICE's clinical guideline on falls in older people states that people presenting for medical attention after a fall, people reporting recurrent falls in the past year, and people who show gait or balance abnormalities should be offered a multifactorial falls risk assessment. This should be done by a healthcare professional with appropriate skills and experience, usually in a specialist falls service. People reporting recurrent falls or assessed to be at risk of falls should be considered for individualised, multifactorial interventions. These should include a gait assessment, and strength and balance training. For people at risk of falls, GaitSmart provides 2 functions, an objective assessment of gait and a personalised exercise programme.

People having joint replacement

2.3 NICE's guideline on joint replacement (hip, knee and shoulder) outlines the treatment options that are available for people who are offered primary elective hip, knee or shoulder replacement. Referral for surgery should be considered for people who have knee or hip joint symptoms (pain, stiffness and reduced function) that substantially affect their quality of life. They should have been offered non-surgical treatment options, or have symptoms that have not resolved with the core non-surgical treatment options. A GaitSmart assessment would be offered as part of pre- and postoperative management. The focus of the GaitSmart programme is to strengthen muscles in preparation for surgery, and to support recovery after surgery.

Innovative aspects

2.4 The innovative aspects of the technology are that it uses a fully automated process to identify each gait cycle from the sensor data and extracts key gait kinematic features. Muscle weakness can also be calculated using this data. Key features from the gait data are presented in a report that uses traffic light coding and scoring to aid understanding for clinicians and patients. The personalised rehabilitation programme is also produced automatically, and generates 6 exercises based on the muscles that need strengthening. The company claims that GaitSmart would improve gait assessment and choice of intervention, and increase access to objective gait analysis, which may result in benefits from improved patient outcomes.

Intended use

2.5 The GaitSmart programme is intended for people who are ambulatory or partially ambulatory with gait and mobility issues. This evaluation focuses on people at risk of falls, and people having hip or knee replacements. The GaitSmart assessment is intended to be done by a healthcare assistant. Additional training on using the technology and reading the report is needed for healthcare professionals and people having treatment.

Costs

2.6 The cost of GaitSmart was calculated by the external assessment group (EAG) to be £82.00 per user. This includes the costs of 4 sessions of GaitSmart assessment, the vGym rehabilitation exercise programme and employing a healthcare assistant to do the tests. The cost of each GaitSmart session is £10.00 (£40.00 for 4 sessions). The cost of employing a band 4 healthcare assistant for 4x15 minute sessions was estimated to be £34.00. The EAG also included 5 minutes of physiotherapist oversight time, estimated to be £4.58. Administration costs for 10 minutes per user was estimated to be £3.42. There is an additional one-off cost of £1,000 for loan of the GaitSmart system to the NHS and for training. This cost was not included in the economic modelling. For more details, see the website for GaitSmart.