Development and evaluation of the cane use cognitive mediator instrument

Canes are among the most underutilized assistive devices for older persons. A significant obstacle to understanding cane use behaviors of older adults is the lack of instruments measuring factors that may influence seniors' decisions to accept or reject these devices.

Guided by the Theory of Planned Behavior, this study involved the development and evaluation of an instrument to measure cognitive determinants of cane use among community-living older adults.

The two-phase design involved: a) instrument formation including item generation from four focus group interviews with seniors (n = 30), expert panel evaluation (n = 10), and pilot testing (n = 10); and b) instrument validation in a cross sectional survey (n = 106).

Psychometric analyses of survey data provided empirical evidence of the construct validity and reliability of the instrument. Principal components analysis verified the hypothesized four-factor solution, explaining 63.2% of variance. Independent t-tests yielded statistically significant differences (p < 0.001) in mean scores between the two contrasting groups of cane users (n = 51) and nonusers (n = 55) with respect to each of the four factors identified. Alpha coefficients of 0.81 to 0.96 indicated high internal consistency of the instrument.

The instrument can be used by clinicians and researchers to assess seniors' salient beliefs about the consequences of cane use, guide tailored intervention strategies to promote acceptance and effective use, and evaluate the effectiveness of interventions.