Adaptation of the clinical limits of use tool (CLOUT): Clinical and environmental testing of off-road mobility...

This study presents a case-based application of the Clinical Limits of Use Tool (CLOUT), specifically its clinical device testing component, to evaluate an off-road mobility device, the Invacare Top End Force CC handcycle. This component of CLOUT was operationalized into measurable variables and standardized test procedures through collaboration among therapists, engineers, and advisory expert users. The evaluation included structured interviews and controlled off-road testing assessing assembly, seating and positioning, transfers, obstacle negotiation, slope performance, terrain interaction, and safety.

The results demonstrated that the handcycle performed effectively on moderate terrain, including dirt, gravel, and grass, and successfully navigated slopes up to approximately 29° and smaller obstacles. Performance limitations were identified in larger obstacle negotiation due to low ground clearance, as well as in transfers due to low seat height and limited support. Device performance was influenced by user strength and environmental conditions.This case study demonstrates how CLOUT can be applied as a structured and reproducible framework to evaluate mobility device performance in non-clinical environments. The findings highlight the importance of aligning user ability, device characteristics, and environmental demands to support safe and effective mobility. This approach may inform clinical decision-making, user training, and future development of standardized evaluation methods for off-road mobility technologies and beyond.