Effects of Self-Selected Handrail Use on Foot Placement and Centre-of-Mass Control During Unperturbed Stair Descent in Older Adults

Introduction: Stair descent is a major cause of falls in older adults, accounting for significant morbidity, mortality, and healthcare costs. Handrails are widely recommended for enhancing stair safety, mainly because they can be used to arrest a fall if stability is perturbed. However, little is known about the biomechanical impact of handrails when used with the intention to avoid postural instabilities, before the need arises to arrest a potential fall. This study explores whether using the handrails in a self-preferred way during stair descent affects biomechanical parameters associated with fall risk in older adults. Method: Fourteen older adults (age: 72.6 ± 6.2 years) descended a seven-step staircase in two conditions: self-selected handrail use and no handrail use. Motion capture data were used to determine the proportion of foot length in contact with the step (PFLCS), as well as peak Centre of Mass (CoM) acceleration and velocity during the landing and lowering phases and variability. Paired- samples t-tests or Wilcoxon signed-rank tests were applied for statistical comparisons, as appropriate. Results: PFLCS or CoM parameters during landing or lowering. showed no significant differences. Handrail use was associated with a significant increase in CoM peak acceleration variability during the lowering phase (p = 0.012, Cohen’s d = 0.87). Conclusion: The similarity in PFLCS between conditions indicates that, in the present study, allowing participants to use the handrail in a self-selected manner did not produce a measurable improvement in foot placement on the step. Greater variability in CoM peak acceleration during the lowering phase suggests less consistent movement patterns when using the handrails. This increased variability may be linked with perceived assurance that a fall could be arrested if a destabilising event occurred, although the mechanism underlying this finding remains unclear. Given the laboratory conditions, the task may not have been sufficiently challenging for healthy older adults with low concern about falling; therefore, using the handrails in their preferred way did not have a measurable effect in terms of safer stepping behaviours. Future research should assess handrail use under more demanding, real-world conditions.