Current Use of Gait Belt in Hospitals of Certain Areas in China

LUO Mi ,YUE Guang ,MU Keli

1 Kunming Medical University,Kunming,Yunnan 650500,China;

2 Wangjing Hospital of China Academy of Traditional Chinese Medical Science,Beijing 100102,China;

3 School of Pharmacy and Health Professions of Creighton University,Omaha,Nebraska 68178,USA

ABSTRACT Objective:To investigate the current status of gait belt use in the hospitals in China and to ex‐plore the factors that are related to the decision-making of Chinese rehabilitation practitioners.Methods:Survey method was used in the study.A survey questionnaire was developed and distributed through the social media We‐chat.SPSS 24.0 software was used to complete the statistical analyses.Results:A total of 378 questionnaires were returned.The results showed that most participants had never heard about gait belt (64.0%).The awareness of gait belt was significantly associated with the professions of the participants(P=0.038).The resources in which participants learned about gait belt were mainly textbooks,journals,internships,friends,coworkers,and the inter‐net.Among the 136 participants who had heard about gait belt,forty-seven (34.6%) of them reported the reason for using gait belt was because it was convenient,safe,and energy saving.Most of the participants didn't use it on patients (65.4%) even though they knew about gait belt.Almost all the participants who did not know gait belts voiced that they were willing to use it once they understand the benefits of gait belt use and ways to use it correctly(92.2%).Conclusion:Gait belt is not widely known and used by the participants.Rehabilitation practitioners'knowledge of gait belt is the most important factor that is related to the use of gait belt in China.To advocate gait belt use,awareness and education of gait belt should be considered as the first step which can be implemented in various ways,such as required content in the professional school curriculum,in continued education and review of pertinent literature.At the same time,the access to gait belt,which can be facilitated by the leaders in health‐care facilities,would contribute to this advocacy remarkably.

KEY WORDS occupational therapy;rehabilitation;Chinese hospital;gait belt;patient safety

Mobility is necessary for patients to achieve maxi‐mum access to environments and objects of interest to them［1］.Mobility also helps to avoid adverse events caused by long-term bedridden,for example,deep vein thrombosis［2］，hypostatic pneumonia［3］，pressure sore［4］and disuse atrophy［5］.Therapists should assist or supervise the mobility when a patient has some physical or cognitive limitations,and they must be aware of the use of correct moving and lifting tech‐niques to ensure safety for patients and themselves［1］.Gait belts can be used to control patient's balance and prevent patients from falling when gait belts are used to transfer and train patients who have limited capaci‐ty of weight bearing or can partially perform ambula‐tion.They have also been used in research tests to en‐sure the safety of the patients throughout the tests［6］.GEORGE［1］discussed that occupational therapist(OT)can prevent patients from falling by using a gait belt since the risk of falling was always present when func‐tional mobility was addressed with patients.When transferring a patient,a gait belt offers a place to grasp and secures the patient handling［7］.Fall risk would be reduced when the practitioner can grasp the patients more effectively.A gait belt with hands-on guidance can provide them a sense of security while walking indoors or outdoors［8］.In the meantime,us‐ing gait belts can release the lower back pain of care‐givers［9］.LAFLIN and AJA［10］also stated "OWEN and GARG's (1993) finding that gait belt use lowers spinal compressive forces reinforces our commitment to encourage staff members to use this lifting aid".

Caregivers and health care practitioners in hospitals in China usually lift patients by using the under-axilla transfer technique,or grasping belts or pants on pa‐tients,which can be physically stressful.Research has found 56.9% of the nurses in China suffered from lower back pain,and 74.3% of them sustained a con‐stant pain［11］.Transferring heavy patients can be un‐safe for practitioners because of the biomechanical stresses on their backs which are beyond the compres‐sion tolerance limits of spine［10］."The frequency of carrying out these tasks,combined with the cumula‐tive nature of the insults,is important to the problem of back injuries"［9］.Patients in hospitals in China may fall because of weakness,diseases,and environmental unfamiliarity.Among the patients who fell,40.2% of them were elderly people and 64.5%of them sustained cerebrovascular accident(CVA).Approximately 24%-47% of the falls occured during rehabilitation treat‐ment［12-13］.Physicians in China found falling to be physically and psychologically harmful to patients,and can delay the recovery［14］.ZHOU,et al.［14］con‐ducted a research in a Chinese hospital and found out that about 8% patients fell while being transfered,and 20% patients fell while receiving rehabilitation treat‐ment.

Gait belt is a helpful low-tech assistive device,which can be adjusted to fit around patient's torso,un‐der buttocks or thighs depending on different health conditions［15］,to reduce patient's fall risk.However,current research literature on gait belt use in China was very scarce.Research literature on ways to trans‐fer patients in and out of wheelchairs or beds safely and effectively in China was missing.

The purpose of this study was to investigate the cur‐rent status of gait belt use in hospitals in China and explore factors that are related to the decision of using or not using gait belt.

1 Methods

This research used a survey method.Both quantita‐tive and qualitative data were collected.Snowball sam‐pling strategy was used to survey health care practitio‐ners in China.Participants of the study were healthcare practitioners in rehabilitation department and other health care departments in Chinese hospitals includ‐ing rehab physicians,nurses,physical therapists(PTs),and occupational therapists (OTs).As rehabilitation services are provided in various settings,therefore,dif‐ferent levels of hospitals were included in this study.

In this study,participants were asked to respond to a self-developed survey questionnaire.The question‐naire was developed based on extensive literature re‐view and several revisions.Both open ended and close ended questions were included in the questionnaire.Questions on the questionnaire inquired participants'knowledge of gait belt,ways to gain such knowledge,reasons for using or not using the gait belt and their willingness to use or not use gait belt in the future once they understand the benefits of gait belt.Demo‐graphic information of the participants was also gathered at the beginning of the questionnaire.

The survey was generated and managed online using WenJuanXing (WJX),which is a widely used online survey tool,and distributed through the social media Wechat,a popular social application in China.The survey was sent out to the potential participants via Wechat whom authors have connection with,then the participants sent it to other healthcare practitioners they knew after they had completed the survey.Practi‐tioners,who were willing to participate,could just simply click the survey link on their phones or com‐puters.The survey was open for four weeks.SPSS 24.0 software was used for data analyses.

2 Results

The majority of the 378 healthcare practitioners(95.0%) who participated in the study worked in cities.The participants included physicians,PTs,OTs,and nurses.Over half of the participants were physi‐cians (54.2%).The educational degrees of the partici‐pants ranged from bachelor's degree to doctoral de‐gree and most of the participants held bachelor's de‐gree (76.5%).The participants' educational backgrounds varied considerably.For data analysis purpose,participants' educational backgrounds categorized into 3 groups:modern medicine rehab (occupational thera‐py,physical therapy,rehabilitation science),traditional Chinese rehab (acupuncture,acupuncture and rehab),and others (clinical medicine,pediatrics,orthopedics,cardiology,neurology,Chinese medicine,laboratory medicine,etc.).The demographic information of the participants was presented in Table 1.

Table 1 Participant demographics

Currently,when transferring and handling patients,over half of the participants placed hands on patients'waists (55.3%).Nearly sixty-four percent of the par‐ticipants (64.0%) had never heard of gait belt.For those who did hear about it before,they learned about gait belt mainly from textbooks,journals,internships,friends,coworkers,and the internet.Thirty-six per‐cent (36.0%) of them reported that they used gait belt in practice and the reasons for using it were the conve‐nience of gait belt,safety concern,and energy saving.Over sixty-five percent of the participants (65.4%)among those who had heard of gait belt before,how‐ever,did not use gait belt in practice.The stated rea‐sons for not using gait belt were the unavailability of the gait belts in the work site (50.6%) and practitio‐ners did not feel having enough knowledge (34.8%).Almost all the participants who had not known about gait belts expressed that they were willing to use it if they knew the benefits and the right way of using gait belts (92.2%).Participants' responses to the survey questionnaire were summarized in Table 2.

Table 2 Patient handling/gait belt related demographics

Table 3 Factors that influence participants' awareness of gait belt（n，%）

Inferential data analysis revealed that the location of the employment,the profession of the participants and the educational backgrounds of the participants were factors that were related to the understanding and knowledge of gait belt.Participants employed in the city heard about gait belt outnumbering their coun‐terparts in the urban or rural areas.OTs and PTs showed significantly more awareness of gait belt than physicians and nurses.Participants majored in modern medicine rehabilitation had significantly more aware‐ness of gait belt than counterparts in other majors.No significant differences were found among participants'highest educational degrees or the hopital levels at which the participants worked.See table 3.

Analyses of answers to open ended questions sug‐gested the main reasons that gait belt were not widely used included inadequate knowledge of gait belts among health care practitioners,limited understand‐ing of rehabilitation and patients family's involvement in handing and positioning.Participants suggested that"practitioners in rehabilitation departments should be introduced and trained about how to use gait belts so that they can educate patients on gait belt use." "It is usually family members who transfer patients in hos‐pitals in China." "In most areas,especially in less de‐veloped ones,there is a lack of awareness even among the doctors that some patients need rehabilitation to improve their activities of daily living(ADLs).This is not only related to the underdeveloped economy,but also to the lack of medical concept".

Analyses of open ended questions also showed that some participants chose not to use gait belts in prac‐tice even they knew it.The reported reasons for not using the gait belt fell into two categories including 1) gait belts were not available in their hospitals(50.6%),and 2)participants didn't have enough knowledge related to gait belt (34.8%).The participants voiced,"My hospital doesn't provide gait belts for us." "I don't know the benefit of using it","I don't know how to use it".Some PTs were considered not having enough knowledge about gait belt when they an‐swered,"It is not related to my job." Doctors who an‐swered,"I don't need to transfer patients when I work"were classified to the third category,"not related to their job".

3 Discussions

While rehabilitation has a long history in China,the development of modern rehabilitation in China just started several decades ago.There is a growing need for modern rehabilitation and its related knowledge.Gaining an understanding of the current state of gait belt use in China and factors related to gait belt use can help rehabilitation practitioners develop a plan to advocate and facilitate the gait belt use in practice.

The finding of this study has shown that currently in China,gait belt use is not common with 65% of participants had not even heard about gait belt.More‐over,among those who knew gait belt,over sixty per‐cent(60%) of practitioners chose not to use it due to the lack of gait belt at sites or not having needed knowledge of using it.Another factor related to gait belt use lies in the Chinese tradition and culture.The desire and expectation of being independent is much lower in Chinese culture than western culture as many rehabilitation patients especially older adults expect to be taken care of by their family members such as with transfers and mobility.

Such findings suggest the urgent need to advocate,educate and encourage the use of gait belt in China.Education programs in rehabilitation need to add or strengthen the content on gait belt use such as the con‐cept,benefits and correct techniques of gait belt use.In-service training and continued education on the use of gait belt is another efficient way increasing practi‐tioners' knowledge and skills of gait belt use in prac‐tice as participants have revealed internship and learning on the job as primary sources of acquiring under‐standing,knowledge and skills of gait belt use.The access to gait belt,which can be improved by the lead‐ers in healthcare facilities,would contribute to the use of gait belt in practice remarkably.An encouraging finding,however,is over 90% of the participants voiced their willingness of using gait belt if they had known about gait belt.Once healthcare practitioners are properly educated,one would expect the vast ma‐jority of practitioners will be able to use gait belt in practice.

Findings of the study have revealed the significant relations between gait belt use and other pertinent fac‐tors,such as the profession,location of employment and educational background of participants.The awareness of gait belt was significantly associated with the profession of the participants.Compared to physi‐cians and nurses,more OTS and PTS knew about gait belt (P=0.038).This is an encouraging finding as one would expect rehabilitation therapists have more un‐derstanding of gait belts and use them more frequent‐ly due to their roles and responsibilities.

An interesting significant finding of the study is participants with modern rehabilitation training were more aware of gait belt than their counterparts with traditional Chinese medicine training (48.7%vs.22.6%,P=0.003<0.05).The finding suggests while traditional Chinese medicine has its long history and is an important component of rehabilitation in China,the education and training in gait belt use seems more incorporated into the modern rehabilitation curricula.Traditional Chinese rehabilitation training historically and conventionally focuses on acupuncture,massage,and Chinese herbs.

Participants employed in the cities seemed to have much more awareness about gait belt than their coun‐terparts in suburb and rural areas and such difference reached a significant level(37.0%vs.15.8%,P=0.06<0.05).One explanation for the significant difference is in general,people in China favor living and working in big cities.With the severe shortage of rehabilitation professionals,rehabilitation graduates from top-ranked programs are most likely to find jobs in higher-level hospitals in metropolitan cities.Modern rehabilitation knowledge,skills,techniques as well as equipment and device are usually associated with higher-level hospitals and facilities located in big cities.Future re‐search studies need to investigate such speculations.

Several limitations existed in this study.First,snow‐ball sampling was used in the study which limited the generality of the study.Moreover,the data for the study was mostly collected from practitioners working in the hospitals in China.The findings of the study cannot be generalized in other health care settings.Secondly,a self-developed questionnaire was used in the study.The psychometric properties of the ques‐tionnaire such as validity and reliability had not been examined.Lastly,due to the sampling strategy and the data collection methods used,it was not possible to know the response rate of the study which may have confounded the findings of the study.Future re‐search studies need to involve a larger sample with random sampling method.Participants of the study need to be recruited from various practice settings such as hospitals,health care clinics and assistive living facilities,etc.Additionally,psychometric properties of the questionnaire need to be examined in the future research studies.

4 Conclusion

In this study,the investigators of the study aimed to examine the current use of gait belt in Chinese hospi‐tals.Gait belts are widely used in western countries such as in USA when transferring and providing inter‐ventions to patients.Gait belt,however,has not been widely used in Chinese hospitals.The limited gait belt use in China is largely due to the lack of awareness and understanding,poor accessibility as well as inade‐quate training and education.Policy makers,adminis‐trators,educators and practitioners in China need to advocate the use of gait belt,provide the knowledge and training,and encourage gait belt use in rehabilita‐tion practice in order to ensure patients and practitio‐ners'safety,improve patient care,and ultimately bene‐fit both patients and practitioners.

Author note

This research study was conducted in partially ful‐filling the requirement of master program in occupa‐tional therapy at Creighton University.The authors wish to thank Dr.LUO Zhiyong of the Second Affili‐ated Hospital of Kunming Medical University and Dr.QI Yongyue for their assistance during the process of study implementation and manuscript preparation.