Proefschrift

Chapter 9 134 €9,836.96 over six months. Unexpectedly, total societal and healthcare costs were lower for patients with a paid job relative to patients without a paid job. The ADL was, respectively 10.4 at baseline and 49.5 at 26 weeks post-surgery treatment. The Quality of life (QoL) at baseline was 0.3 and at 26 weeks post-surgery treatment it was 0.7. These findings are indicative of a significantly improved ADL and QoL (p<0.05) over time. In chapter 5, the newly designed permissive weight bearing protocol presented in chapter 1 was implemented in a patient population from Adelante Rehabilitation Center in Hoensbroek, the Netherlands. The protocol, designed as a new aftercare mobilization regimen within the upper boundary of the therapeutic bandwidth, yet safe enough to avoid overloading, has been further elaborated in this chapter. The first experience in 150 surgically treated trauma patients with peri- and/or intra-articular fractures of the pelvis and lower extremities has been investigated. The study showed that the median time to full weight bearing was 12.0 weeks [IQR 6.8, 19.2]. The complication rate during rehabilitation was 10%, which is comparable to the complications rates in the literature. In chapter 6, quality of life and pain, and number of complications in patients with surgically treated tibial plateau fractures who followed a permissive weight bearing (PWB) regime, relative to those that followed a restricted weight bearing (RWB) regime were compared. This cohort study included 91 patients with a tibial plateau fracture (31 and 60 patients in the PWB and RWB groups respectively). No between-group differences in either age or gender were found. However, a significant difference in fracture type was found between groups, (p=0.04). No differences were found in either patient-reported SF-12 (quality of life) or VAS scores (pain) between the PWB group and RWB group. Time to full weight bearing was significantly shorter in the PWB than in the RWB group, i.e., 14.7 versus 20.7 weeks, (p=0.02). No differences were found regarding postoperative complications between the PWB and the RWB groups, i.e., 6.5% versus 10.0%, respectively. In the study reported in chapter 7, the aim was to investigate the effectiveness of a PWB in surgically treated trauma patients with peri- and intra-articular fractures of the lower extremities. This study reports on patients’ self-perceived outcome levels regarding activities of daily living (ADL), quality of life (QoL), pain and weight bearing compliance, in comparison to restricted weight bearing (RWB), over a 26-week postsurgery follow-up period. This study included 106 trauma patients (N=53 in both the PWB and RWB groups). Significantly better ADL and QoL were found in the PWB group compared to the RWB group. There were no differences in postoperative complication rates between the PWB and RWB groups.

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