This study will use an assessor-blind, 2-site parallel-group, randomized controlled trial (RCT). This study protocol was registered on ClinicalTrials.gov (NCT05347875). The SPIRIT (Standard Protocol Items Recommendations for Intervention Trials) guidelines [41] and the CONSORT (Consolidated Standards of Reporting Trials) statement [42] will be followed.

To be included in this study, participants should be aged 18 years or older, should use a walking aid (cane, crutch, or walker) for at least 75% of ambulatory time (self-reported), and should be able to communicate in English or French. Participants will be excluded if they have a progressive condition or injury that may restrict or be worsened by walking aid use (self-reported) or a visual impairment that could limit their ability to interact with a mobile app (self-reported). Reasons for exclusion, declining participation, and dropout will be documented for CONSORT purposes (Figure 1) [33,42].

Participants will be recruited from clinics, community centers, semiprivate assisted living facilities, and via social media and emails distributed to health care practitioners by the study coordinators (FN and RHKM). Recruitment posters will be distributed, and emails will be sent to community associations and organizations, practitioners (kinesiologists, physiotherapists, and occupational therapists) in contact with walking aid users, and all university and research center networks. Active approaches, such as community meetings with presentations and collaboration with community partners in identifying potential participants, will also be used. The study coordinators from the 2 sites (FN for Québec and RHKM for Calgary) will contact interested, eligible participants via email and telephone and send them a consent form at least 24 hours before the first evaluation.

The sample size calculation was based on the Activities-specific Balance Confidence (ABC) scale questionnaire (primary outcome) [43]. No study has reported the minimum clinically important difference for the ABC scale among walking aid users. However, considering a study on 376 patients with knee osteoarthritis who had undergone surgery (many of whom used a walking aid), ABC scores increased by an average of 9.2% 1 year after total knee arthroplasty (repeated measures model; Cohen d=0.59) [44]. On the basis of the variability reported in the study [44], an estimated correlation of 0.5 between measurements, including ABC scale and 2 potential covariates (type of walking aid and duration of walking aid use), a sample size of 45 would be sufficient to explore a 2-way difference between groups (F tests) in a 2-way repeated measures model (2 groups×2 time points; 1–β=.9; α=.05; G*Power [Heinrich Heine University Düsseldorf]) [45]. With a conservative dropout rate estimated at 15% [46], a total sample size of 52 participants is enough to find significant differences between groups for the primary outcome. To minimize participant dropout and ensure high retention rates, several strategies will be implemented. These include clear and transparent informed consent procedures, regular and supportive communication with participants, and flexible scheduling for study visits. Efforts will be taken to maintain a strong and supportive relationship between the research team and participants. All participants will be reassured about the confidentiality of their data and the importance of their contribution to the success of this study.

The study procedures (timeline and measurement tools) are illustrated in the SPIRIT checklist (Table 1). Participants will be assessed at 3 time points: baseline (T1), after intervention (T2), and 4-week follow-up (T3). After signing the consent form, a study coordinator will schedule the first evaluation session (T1). Preintervention questionnaires will include sociodemographic data (eg, age, sex, gender, walking aid type, reasons for using the walking aid, the duration of walking aid use, and previous walking aid experience), the ABC questionnaire, and self-reported knowledge and confidence in fitting and using the walking aid using a tablet or laptop. Participants will then complete the Walking Aids Skills Test (WAST) and mobility tests (6-Minute Walk Test, 6MWT and Timed Up and Go, TUG test).

All data will be collected by an assessor who will be blinded to group allocation. The T1, postintervention (T2), and follow-up (T3) questionnaires will be imported into the LimeSurvey platform to allow for completion during the evaluation while ensuring secure data management. The collected data will be anonymized with a code assigned to each participant and will be stored on the institutional platform. Access to data will be limited to authorized personnel.

The intervention used in this study is an educational, nonpharmacological approach that adheres to the ethical principles of beneficence and nonmaleficence. Given its low-risk nature, it is unlikely to cause adverse effects. Therefore, the establishment of a data monitoring safety board may not be necessary. However, any adverse effects will be monitored informally by the project coordinators.

Responses to questionnaires and test scores will be imported from the LimeSurvey platform and compiled into a Microsoft Excel file. Descriptive statistics (means, SDs, frequencies, and percentages) will be used to summarize sociodemographic data.

An analysis of covariance will be performed to detect postintervention differences between groups for the primary and secondary measures using the respective T1 score as the covariate. Dropout rates and reasons will be reported. Depending on the nature of the missing data (proportion of missing values), appropriate methods will be chosen with careful consideration of the data structure and the underlying assumptions. The significance level will be set at .05, and all statistical tests will be 2-tailed. The scores from the self-reported questionnaires on walking aid knowledge and confidence will be summed and analyzed using an appropriate parametric test (if normally distributed). Retention of balance confidence, mobility, and self-reported score of knowledge in the experimental group will be evaluated using 2-tailed paired t tests. Sensitivity analyses will also be conducted based on walking aid type, walking aid use experience, previous training, and the main reason for use. All analyses will be performed in SPSS software (version 27; IBM Corp).

This study protocol has been approved by each of the 2 sites’ board committees: the Centre Intégré Universitaire de Santé et des Services Sociaux of the Capitale Nationale Rehabilitation Sectoral Ethics Committee, Québec (approved on June 10, 2024; 2025-3085) and the University of Calgary Conjoint Health Research Ethics Board in Alberta (REB25-1290). Written informed consent will be obtained from the potential participants. Any modification to the protocol will be reviewed and approved by the corresponding ethics boards and will be reported to all investigators during the team’s monthly meetings.

During the study, the information about participants will be kept confidential, and signed informed consent will be obtained after the participants agree to participate in this study. The whole procedure will strictly follow the principles of voluntariness, confidentiality, and no harm. Participation is entirely voluntary, and participants may withdraw from the study at any time without providing a reason. Withdrawal will not affect access to health services, medical treatment, or any other rights to which participants are entitled.

To protect participant privacy, all data will be stored on secure, password-protected institutional servers and managed within the institution’s Microsoft Teams environment, which provides encrypted, access-controlled data storage. Access to study folders on Microsoft Teams will be restricted to authorized members of the research team who have completed the required institutional privacy and security training. Identifiable information will be stored in a separate, access-restricted location and will not be linked to research data except through encrypted identification codes. All datasets used for analysis will be fully deidentified, and no personally identifying information will appear in any presentations, publications, or knowledge-translation materials. Data storage, retention, and destruction will follow established institutional policies and provincial regulatory requirements.

To minimize participation burden, participants will receive financial compensation of CAD $25 (US $32.50) for each assessment session and will be provided with a parking-lot pass for every in-person visit.

Through this single-blind, 2-site RCT, we aim to evaluate the primary hypothesis that an education and training tool for the correct use of walking aids will effectively improve balance confidence and secondarily may influence mobility and walking aid skills. This study protocol should allow us to determine whether the novel video-based feedback educational tool, designed to teach and train fitting and safe use of walking aid, is effective in improving balance confidence, mobility, walking skills, and knowledge. This is an exploratory RCT, given the paucity of literature on the effectiveness of mobile educational apps on short- and long-term walking aid use.

To meet the challenges of the lack of formal training programs for users on the fitting and use of walking aids and the lack of standardized information for health care professionals, mHealth apps may constitute an affordable and scalable digital health intervention to address these growing gaps. The findings from this study will provide valuable insights into the effectiveness of this novel app in improving knowledge of walking aid fitting and safe use as well as improving balance confidence and mobility. Recent evidence suggests that physiotherapy interventions delivered through a smartphone or tablet app were effective in improving mobility outcomes in people with a wide range of health conditions (such as neurological disorders [67,68]). The video-based feedback learning method used by the ICanWALK modules is known for rapidly improving memory recall [69], behavior change [70], and motor skill acquisition [71] and, consequently, should prevent falls while improving functional independence.

The findings of this study may help improve accessibility to health care by reducing the waiting time between the walking aid prescription, purchase, and training with a health care professional. In fact, while some walking aids are owned independently, others are prescribed by health care professionals, with physical therapists being the most common prescribers [72]. Thus, this app would contribute to reducing the waiting time for walking aid prescriptions and training with a health care professional. For instance, more than 10,000 Canadians were reported to be waiting for occupational therapist or physiotherapist services across Ontario [73], and the median waiting time was more than 6 months for 41% of outpatient publicly funded physiotherapy services in Québec [74]. Improving access to mHealth technologies may help address the growing human health care resource challenges in the world [75] and may also enable access to education for people living in remote or rural areas.

Finally, the results obtained from this pragmatic RCT, especially from sensitivity analysis, may help identify specific factors contributing to improved balance confidence, mobility, and knowledge of walking aid users after using an educational tool, such as the type of walking aid, the previous experience using walking aid, and individual factors such as age and diagnosis. This will enable larger-scale studies to be set up by the type of walking aid or the type of condition necessitating the use of a walking aid.

This study may have several limitations. First, we will include participants who use various types of walking aid, but we will not stratify them according to type of walking aid, their digital literacy, cognitive level, user experience, or education. This may result in inconsistent responses to the app. However, sensitivity analyses will help to partially address this issue. Furthermore, participants with cognitive impairments or vision or hearing limitations may face barriers to fully engaging with the app. Second, the primary outcome is a self-reported measure, and this may be subject to measurement bias, such as social desirability bias or recall bias. We believe that the study design, methodology, and expected sample size make the expected results plausible. Finally, this study focuses on a short-term follow-up period and may not capture the long-term efficacy of the app. The key strength of this study will be the use of video-based feedback, as it enables the motor learning process and skills acquisition, leading to high memorization, behavioral change, and performance [69,71,76,77].

To our knowledge, this study will be the first to investigate the effectiveness of an educational tool that teaches and trains the fitting and use of walking aids.