Listening to the patients' voice: a conceptual framework of the walking experience

Abstract

Background: walking is crucial for an active and healthy ageing, but the perspectives of individuals living with walking impairment are still poorly understood.

Objectives: to identify and synthesise evidence describing walking as experienced by adults living with mobility-impairing health conditions and to propose an empirical conceptual framework of walking experience.

Methods: we performed a systematic review and meta-ethnography of qualitative evidence, searching seven electronic databases for records that explored personal experiences of walking in individuals living with conditions of diverse aetiology. Conditions included Parkinson's disease, multiple sclerosis, chronic obstructive pulmonary disease, hip fracture, heart failure, frailty and sarcopenia. Data were extracted, critically appraised using the NICE quality checklist and synthesised using standardised best practices.

Results: from 2,552 unique records, 117 were eligible. Walking experience was similar across conditions and described by seven themes: (i) becoming aware of the personal walking experience, (ii) the walking experience as a link between individuals' activities and sense of self, (iii) the physical walking experience, (iv) the mental and emotional walking experience, (v) the social walking experience, (vi) the context of the walking experience and (vii) behavioural and attitudinal adaptations resulting from the walking experience. We propose a novel conceptual framework that visually represents the walking experience, informed by the interplay between these themes.

Conclusion: a multi-faceted and dynamic experience of walking was common across health conditions. Our conceptual framework of the walking experience provides a novel theoretical structure for patient-centred clinical practice, research and public health.

Keywords: ageing; chronic condition; frailty; older people; qualitative research; walking.

Figure 1

Phases of a systematic review and meta-ethnography.

Figure 2

Flow diagram of included studies.

Figure 3

Conceptual framework describing walking as experienced in the presence of diverse health conditions. The framework uses the metaphor of a mechanical system to explain how people experience walking from the moment they become aware of it. Physical, social and mental walking experiences are framed by context and the activity at hand. These experiences link an individual’s walking-related activities to their sense of self through behavioural and attitudinal adaptations. Reflexively, the individual’s newly revised sense of self, behaviours and attitudes affect future experiences and participation in walking-related activities.