1.1
For adults at risk of falls, GaitSmart rehabilitation exercise programme can be used to treat gait and mobility issues in the NHS while more evidence is generated.
Guidance
1 Recommendations
1 Recommendations
Adults having hip or knee replacements
1.2
For adults having hip or knee replacements, more research is needed on GaitSmart rehabilitation exercise programme to treat gait and mobility issues before or after surgery.
1.3
Access to the technology for adults having hip or knee replacements should be through company, research or non-core NHS funding, and clinical or financial risks should be appropriately managed.
Evidence generation and research
1.4
Further evidence is needed on the clinical effectiveness of GaitSmart, including:
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studies with larger populations
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comparative studies
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adherence to the rehabilitation exercise programme
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adverse effects.
What this means in practice
NICE has made this recommendation because there is evidence suggesting benefits of using GaitSmart in people at risk of falls. But more evidence is needed comparing GaitSmart with standard care in this group of people. GaitSmart would be another treatment option that could fill a treatment gap for some people who may otherwise not be able to access gait rehabilitation services.
GaitSmart is intended to be delivered by a trained healthcare assistant, with referral to a physiotherapist if needed. The cost analysis shows that it is potentially cost saving compared with standard care because it needs less healthcare professional time and resources than in-person rehabilitation exercise programmes.
Evidence generation alongside using GaitSmart in the NHS for adults at risk of falls should enable clinical-effectiveness evidence to be collected to support the benefits shown in evidence already.
These recommendations will be reviewed within 3 years, or sooner if new evidence becomes available. Take this into account when negotiating the length of contracts.
This guidance is not accompanied by an evidence generation plan. Details of the types of evidence that should be generated are included in section 4.12.
Why the committee made these recommendations
The clinical evidence on GaitSmart in people at risk of falls, and people having hip or knee replacements is limited but shows benefits.
Adults at risk of falls
Of the 4 relevant studies in people at risk of falls, 3 measured the clinical effects of GaitSmart. None compared it with standard care, but the results suggest that GaitSmart improves gait and quality of life, and people report less fear of falling.
The cost analysis shows that GaitSmart is potentially cost saving compared with standard care to treat gait and mobility issues in people at risk of falls. Comparator costs for standard care are variable. But GaitSmart is likely to be cost saving if its cost is similar that of standard care. There are also several ongoing or planned real-world evaluations of using GaitSmart in the NHS in this group of people. These may address the uncertainties in whether the clinical and system benefits are realisable in clinical settings in the NHS. So, GaitSmart is recommended for use in this group of people while evidence is generated. NHS organisations that are collecting real-world evidence on GaitSmart are encouraged to share these findings as they become available.
Adults having hip or knee replacements
Of the 3 relevant studies in people having hip or knee replacements, 1 measured the clinical effects of the GaitSmart rehabilitation exercise programme. The results of this small clinical trial suggest potentially greater improvements for people using GaitSmart after surgery compared with standard care. But there is no formal analysis of the differences between the groups, and no evidence on using GaitSmart before surgery.
The cost analysis shows that GaitSmart is cost saving compared with standard care in people having hip or knee replacements. But, in this group of people, there is limited clinical-effectiveness evidence, and no ongoing real-world evaluations. So, more research is needed.