Gait Belts Are a Part of Physical Therapy

From my experience, I feel that appropriate assessment and/or evaluation of gait belt need by a qualified professional (usually a physical therapist), followed by the style/type and strength (i.e. belt or harness; texture, thickness, width and absence or presence, angle/position and location of handles), when it's to be used, application (how and who apply it) and period of time for wear, with sufficient insevice/training; potential problems would significantly be limited to very little to none.   Correct safe support comes first then infection control concerns, which should be initially assess and monitor on-going.  If all of this is seriously taken in consideration and followed through as appropriate, services will be well justified and rendered safely with protection from injury.

NIOSH (National Institute for Occupational Safety and Heath) recently released a statement that declares gait belts are NOT to be used as transfer or lifting devices as they may cause soft tissue or other injuries to the patient.

It means you can’t put gait belts around clients and use them as “handles” to slide clients onto transfer boards or to use them as “handles” to help clients stand up from sitting positions.

But what about ambulation? Think about it this way, if the reason for using the gait belt is because the patient is at risk for falls, than walking with a gait belt may actually provide a false sense of security, which puts both the client and the caregiver at risk.  

As you ambulate with the gait belt, you’ll cross your fingers and hope that the client doesn't fall.

In the best case scenario, if the client does begin to fall, you’ll be strong enough to hold him up with the belt or slowly lower him to the floor using the belt (which incidentally is a lot like using the belt as a lifting device). 

Unfortunately, in many cases the caregiver isn't strong enough to hold or safely lower the client to the ground, and both end up getting hurt.

I am the sibling of a disabled adult who has had numerous "undocumented" injuries, including rug burns on her face. The CAPITAL LETTER phrase regarding gait belts is TRANSFER COOPERATIVE PATIENTS...

Certification/training of staff is imperative, and these devices SHOULD NEVER BE USED to ambulate nor on an unwilling or unpredictable patient.

The lack of documentation of injuries to the patients when USING a gait belt is a major concern. In particular in home settings where staff are not supervised and the patient cannot speak.

My father recently had open heart surgery. He is 78 years old. 3 days after the surgery he walked pushing a wheel chair with a nurse to his side. No gait belt. I was pleased with his progress. The next day while walking with the nurse he fainted, fell backwards and cracked the back of his head on the floor. Suffered a concussion. No gait belt. I wonder if the fall would have been lessened by using the belt? After the fall, some nurses would use the belt others wouldn't although a wheel chair would follow behind him. PTs always used them. Is this inconsistent practice common in hospitals? Any feedback would be appreciated.

I think this is a good discussion.  I am surprised that were shocked by the director's inquiry about the effectiveness about gait belts.  I work in home health and haven't used a gait belt in 8 years.  TIRR is one of the most highly reputable Rehab. facilities there in Houston and have some of the best equipment and facilities; none of them ever use gait belts.  We're talking about a neuro-rehab with TBI and SCI patients.  They have caught on long ago that gait belts aren't effective in MOST situations.

We have recently assigned each patient room (we have about 25) in our SNF a gait belt in order to help reduce the infection control risk associated with using one belt on multiple patients day after day.  We considered assigning each patient their own belt, but needed a more cost effective way to address this, so this is what we decided upon.  We, also, are in the process of re-evaluating our gait belt policy and currently use them in PT routinely.  The nursing staff policy is to use them during ambulation.  As far as fall risk, they don't have a noticable impact on falls, but are the first thing the investigator will ask about after a fall - did we use a gait belt?  Most of our falls are not during assisted transfers or gait anyway, whether a gait belt is used or not, but are when a patient is trying to get up out of the bed, or chair unassisted.  Thanks for the discussion.

Just had a Safety Committee meeting yesterday with a guest speaker who locally owns her own PT company.  One of the topics we asked her to address was the use of gait belts by home health aides and RNs in the transfer of patients, especially in the home setting.  HPH had evidently initiated the use of gait belts about 8 years ago, but it seems without reinforcement during annual education, orientation of new employees, etc. it has fallen by the wayside.  One nurse when asked stated she knew she had some located in a file drawer at her site, but just didn't think about using them.  Out of sight, out of mind.  We asked the guest speaker if she knew of any research or literature in the past 8 years that would indicate they fell out of favor, were shown not to assist in transfers or caused Worker's Compensation injuries or patient falls to increase, but she was not aware of any such references.  I was doing research on the web  at home & discovered your article addressing this very subject.  I appreciate you saving me considerable amount of time in researching this subject.  If anyone on your blog knows of anything to the contrary on the subject, I would appreciate an e-mail prior to next month's meeting (4th Monday @month).  We are also interested in knowing how to clean them due to Infection Control concerns.  When I asked about utilizing the vinyl belts the Manager of DME stated they found them to "cut" into the patient's waist & therefore were not recommended.  Any thoughts appreciated.      

I believe the gentleman recommending no lifting over 35lbs forgot to mention unless it is a vital component to the patient's treatment which transfer training is!   We can't prepare someone to go home with hoyers and EZ-stands.  Our profession HAS to teach and assist patients with transfers and this will require us to lift more than 35lbs at times.  

Do we need a gait belt to do this, probably not.  Has there been a RCT proving using a gait belt will reduce patient falls, not that I've found.  But there also isn't a RCT proving patients 85-95 break more hips during ice hockey than 25-35 year olds.  I think too often EBP tries to apply a rule across a diverse population and falls a little short.

Common sense goes a long ways.  I feel gait belts help control a patient when they are up and about if they are a little unsteady.  If the patient has an incision or other fracture where you'd use one....don't use it and document why.  I think when used incorrectly during a transfer, they increase the risk to the patient a caregiver, but let's not let incorrect use of a tool guide our decision on it's effectiveness.

In my 20 years, I have never not used a gait belt....and I have never had a patient fall while in my care.  I agree with the infection control aspect, and we are considering purchasing vinyl belts for all therapy staff members to overcome this.  If anyone can direct me toward supportive research, especially in fall/injury prevention, I would appreciate it.

If a patient does not have a gaitbelt, can the caregiver use one of the patient's two inch belts as a gaitbelt?

I really appreciated reading this blog.  The use of a gait belt has been an ongoing debate at our hospital.  The primary argument against its use has been that some therapy staff do not feel that they can ergonomically handle the patient at his/her center of gravity if they are holding onto the gait belt.  They tell me that handling and guiding the patient's hips is essential to guiding the patient's body during movement.  That seems to make sense.  However, my position is that the therapist can still handle the patient where it is therapeutically appropriate to do so while having on a gait belt.  If the patient starts to fall or needs to return to being upright, the gait belt will then be available for use.  As soon as someone can convince me that averting a fall of a 200+ lb patient is easier by grasping at their hips versus grabbing onto a gait belt, I'll become a believer that it may not be needed.  Till then, I will continue to promote the consistent use of gait belts, whether the therapist chooses to keep a hand on them or not.

Thank you,

Curtis Marti, OTR/L

I would like any research, studies, articles, etc. that promote the use of gait belts.

We used them during training, and on the job.  Only observed no falls with a client wearing one.

When I went home to care for my mother, I brought mine with me.  Taught my five brothers and two sisters to use it, also.  My brothers stopped dropping her in grocery store parking lots, and on the way to the bathroom.

However, when she did finally enter a nursing home, the last 4 weeks of her life, the bruises she was getting were absolutely horrendous!  One they had to x-ray to be sure it wasn't broken. She insisted that she was *not* being abused, and did not want to transfer to another facility.  The CNAs did *not* use gait/transfer belts.  I offered to teach a class to the staff.

She was 82, had had multiple small strokes, and was virtually unable to assist in any way.  I can't imagine trying to have been her care giver without a belt.

I have been a practicing physical therapist for 22 years.  I was trained to always use a gait belt, but over my working life I have come to disagree with their use in most circumstances - the infection control issue being only one reason.  Those plastic belts are really awful.  I also wonder how long they last if cleaned between each use.

My other reasons for disliking to use gait belts include: 1) they promote really sloppy transfer and/or guarding techniques; 2) they cannot be adequately secured on many patients because of abdominal girth (the belt rides up to under their armpits), and some patients experience discomfort no matter how carefully you adjust the belt; 3) use of a gait belt may be contraindicated if the patient has an incision or an implant under the area that would be covered by the gait belt.  

When using a belt for gait training they may have a place when the patient is able to ambulate well enough that you do not want or need to guard them very closely but may still be unsafe enough (with whatever ambulation device they are using) to need some control.  The other scenario in which I have used a gait belt is when performing sit-stand transfer training with very heavy-duty patients who are wearing hospital gowns, and I feel I really need something to hold onto.  BTW, in an acute care setting one way of solving the infection control issue (when you don't use a gait belt all the time) is to roll up a hospital gown and tie that around the patient.  Unless the patient is extremely obese it works well.  

I am rather disturbed by the statement that losing the gait belt would feel like losing a limb and that the writer fears she would not be able to "amaze" onlookers by being able to transfer patients twice her weight.  If she knew and practiced really good transfer techniques, those transfers could also be performed without the gait belt.

Toni,

Your Nov. blog article on “Gait Belts are a Part of Physical Therapy” brings up more questions than it answers.  As you noticed in your data base search, there is no evidence against using gait belts, which led to your sigh of relief.   However, from a safe patient handling perspective that seeks to protect the patient as well as the health care worker, there is definite evidence against using gait belts for transfers.  Garg et al first published their findings in “A biomechanical and ergonomic evaluation of patient transferring tasks: wheelchair to shower chair and shower chair to wheelchair,” Ergonomics, 1991, vol. 34, no. 4, 407-419, and concluded that “the use of a gait belt is not recommended as it results in high perceived stresses and low patient comfort and security ratings.”  But despite this recommendation and research from Garg and many others, using a gait belt for transfers continues to be a standard practice for most PTs and OTs and is still a transfer technique taught in OT and PT schools.  I have always found this to be curious since these same schools teach EBP but don’t apply this approach to the most basic of equipment, gait belts, or to the most frequent patient handling task performed, transfers.  

In light of all the research on safe patient handling over the past 18 years, none of it supports the use of gait belts to ‘transfer patients twice our size with ease,’ as you mentioned in your blog article.  Even though you feel that using a gait belt for transfers is essential to your practice and that taking your gait belt away would feel like “loosing a limb,” it is still unsafe and not supported by any research.  Thomas Waters suggests that a 35 lb maximum weight limit should be set for patient-handling tasks, “When Is It Safe to Manually Lift a Patient””, AJN, August 2007, Vol. 107, No. 8.  Actually, there is no safe way to lift a patient manually because loads are too great for body mechanics to make a difference.  Using gait belts for gait training makes sense because the therapist can exert some control or influence over the patient during ambulation without getting in the patient’s space and tripping them up.  But they should never be used for transfers, other than with a min assist/contact guard stand step transfer, which actually includes some stepping.  At our facility, we prohibit the use of gait belts with transfers and it is included in our safe patient handling policy.  Our question about gait belt use is… what is the infection control risk if gait belts are shared between patients who have no know infection control risk?    

I enjoyed the post. I am a PT in a rehab snf and the only therapist that promotes the use of gait belts. I am in the process of a literature review of the effectivness of gait belt usage. Can anybody forward me articles promoting the use of gait belts. Thank You.

Thanks for your blog Toni.  It is difficult to look up the articles you cited without the article name, the author and the page number within the journal.  Could you please provide these?

Interesting thread as I am updating my policies regarding the gait belt. I will take the opposite view - there is no available evidence through my searching that shows gait belts prevent falls or injuries. I am one of those like your director who questions their supposed value. I have been transfering and ambulating patients without gait belts for years without anyone going down on me, no dislocated shoulders or wedgies either.

I am not advocating that therapists never use them but I question this insistence on HAVING to use them on EVERY patient.

As for the "doh" part of evidence-based practice you commented on, show me the evidence. EBP is exactly what is being put to use in my opinion when your director questions the usefulness of gait belts. If you believe strongly that they prevent falls, research it. There is no "doh" in EBP - ask a specific question and seek a specific answer, combine that with your expert knowledge and the patients opinion = EBP.

I also thought it interesting that PT is "recommended" to use gait belts but RN's and PCT's are not - do they know somehting we don't know? Do patients fall more regularly in that facility when walking with RN's than PT's?

Thanks for starting the discussion.

Andy

Excellent post.  There are only two places I can imagine steadying a patient without a gait belt...one would result in a dislocated shoulder, the other a wedgie.  Neither seems a viable, nor safe, alternative to the gait belt.

Infection control is an outstanding point.  I used to work on a burn unit, which gave me a heightened sense of infection control.  Or at least I thought it did.  I can't believe the issue of infection control and gait belts never crossed my mind!  Sometimes the simplest, most obvious things escape us.

I think it is a good question...do they really reduce falls or lessen severity of injury?  Sadly, I work in an institution where PTs are recommended to use belts with high risk patients, but RNS and PCTs are not...I wonder why the double standard?  The opportunity for falls exists much more with nursing because (hopefully) they are being mobilized during "non" PT times.  Time and time again, I've seen two RNs or PCTs grab a patient under the arms and simply "lift and swing" the patient to their desired destination.  Certainly not safe, and certainly not functional.  Our rate of injury among nursing and PCTs is high (in my opinion...I treat them all in the OP clinic). yet, RNs are required to be performing fall assessment risks and are determining who is a "high fall risk" yet why no gait belt?

Regarding infection control, we have changed to plastic coated belts which can be easily cleaned...they don't function as nicely as the canvas belts, but still serve their purpose.  

Good comments.