Proefschrift

PWB insurgically treated trauma patients with peri- and/or intra-articular fractures of the lower extremities is cost effective 105 The PWB treatment involves a gradual progression in functional activities guided by patients’ subjective experience (pain and confidence to bear weight) and by objective clinical symptoms of the patients occurring during the process of rehabilitation. Clinical symptoms include the evolution of signs of inflammation, neurovascular status, weight-bearing tolerance, changes in the alignment of the affected side of the body, and the quality and function of the soft tissue and the joints involved. This progression in patients’ functional activities is determined from the quality of performance of a functional activity. The progress in therapy is not determined by any predetermined or fixed degree of loading of the affected side in kg or in percentage of body weight, as this has proved to be difficult to adhere to. This process enables patients to carry out the activities with normal/optimal motor skills as soon as possible. The approach is guided by the quality of performance and the safety of the activity (e.g. preventing stumbling). The next stage of the treatment is started when the gait pattern associated with the current stage of the treatment is optimally executed, and can be performed by the patient safely and independently.5 The PWB treatment involves multidisciplinary collaboration with surgeons, rehabilitation physicians and physical therapists, which is considered paramount to safely use the PWB protocol.5 In the RWB group, the patients underwent a non-weight bearing regime for 6–12 weeks followed by partial weight bearing with a 25% increase in weight loading every week according to the existing (AO-) guidelines.2 The baseline characteristics in the study were collected from the electronic medical records by two researchers (PK and CM). Baseline characteristics included: age at time of fracture, gender, ASA (American Society of Anesthesiologists, assessing the fitness of patients before surgery, type 1–6),14 Charlson-comorbidity score (classifying prognostic comorbidity, a higher score representing additional comorbidities),15 type of fracture and the length of hospital stay (in days). Economic outcomes This study includes a cost-effectiveness analysis (CEA) and a cost-utility analysis (CUA). The outcome measure of the cost-effectiveness analysis (CEA) was the patient-selfperceived outcome questionnaire, a measure for the Activities of Daily Living (ADL). The patient‘s self-perceived outcome questionnaire was taken at week 2, 6, 12 and 26 postsurgery. The ADL was measured with the Lower Extremity Functional Scale (LEFS). The LEFS consists of 20 questions about a person’s ability to perform daily tasks. Each question can be scored from 0 to 4, where 0 represents the extreme difficulty to perform the activity. The maximum possible score is 80 points. The lower the score, the greater the disability.16

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