Proefschrift

Summary 133 Summary This dissertation focuses on: 1) the current state of practice among surgeons in the Netherlands regarding post-treatment weight bearing protocols 2) the current economic burden regarding non or restricted weight bearing 3) a comprehensive protocol for permissive weight bearing and 4) the (cost) effectiveness of permissive weight bearing versus non- or restricted weight bearing (current guidelines). As mentioned in the introduction (chapter 1), the permissive weight bearing protocol has been conceptualized as a new aftercare mobilization regimen to optimize rapid clinical recovery and the restoration of function and functionality in surgically treated trauma patients with peri- and intra-articular fractures of the lower extremities. Since 60 years, the current paradigm of aftercare treatment in surgically treated trauma patients with peri- and intra-articular fractures of the lower extremities has not changed, namely non- or restricted weight bearing during 6-12 weeks. However, studies substantiating the non- or restricted weight bearing protocol are lacking. In addition, studies comparing permissive weight bearing versus non- or restricted weight bearing are scarce. Therefore, more evidence is needed regarding the permissive weight bearing protocol. In chapter 3, a web-based survey among members of the Dutch Trauma Society and Dutch Orthopaedic Society is presented, identifying the most commonly applied protocols in terms of the post-operative initiation and level of weight bearing in patients with tibial plateau fractures and the surgeons reasoning behind this choice. One hunderd and eleven surgeons responded to the survey; 72.1% of the respondents recommended starting weight bearing earlier than the 12 weeks recommended by the AO guideline (current guideline); 11.7% recommended starting weight bearing immediately, 4.5% after 2 weeks and 55.9% after 6 weeks. Moreover, 88.7% of the respondents reported deviating from their own local protocol. There is little consensus about the definition of 100% weight bearing and how to build up weight bearing over time. This study demonstrates that consensus about the weight bearing aftercare for tibial plateau fractures is limited. A large majority of surgeons do not follow the AO guideline or their own local protocol. In chapter 4, in a prospective cohort study, the cost of illness in surgically treated trauma patients with peri- and/or intra-articular fractures of the lower extremities was estimated through a bottom-up method. The Dutch EQ-5D-5L questionnaire was used to calculate utilities while Lower Extremity Functional Scale (LEFS) scores were used as a measure of Activities of Daily Living (ADL). Subgroup analyses were performed to determine the influence of work status. Furthermore sensitivity analyses were performed to test the robustness of the results. Total average societal costs were

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