Proefschrift

Study impact 141 Study impact Main research goal The main research goal of this thesis was the comprehensive assessment in terms of ADL, quality of life, pain, postoperative complications and costs of permissive weight bearing versus the current standard restricted weight bearing aftercare protocols in surgically treated trauma patient with peri- and/or intra-articular fractures of the lower extremities. Permissive weight bearing (PWB) is effective and cost-effective and can be used as a novel approach in the aftercare treatment in surgically treated trauma patient with peri- and/or intra-articular fractures of the lower extremities. The PWB regimen led to the patients being able to bear full weight on their affected leg much sooner, with improved Activities of Dialy Living and quality of life, compared to those who followed the current restricted weight bearing (RWB) regimen. No significant differences between the two treatment regimens were found in either postoperative complication rates or pain levels. Furthermore, total costs were lower in the PWB group in comparison to the RWB group. In terms of cost per improvement in ADL (as measured with the Lower extremity functional scale) the PWB group showed higher effects and lower costs. Looking at the quality of life the PWB group had comparable QALYs to the RWB group while the costs were lower. Therefore, as stated earlier in this thesis, these results show that PWB can be seen as a promising aftercare treatment in surgically treated trauma patient with peri- and/or intra-articular fractures of the lower extremities. This means, the PWB contests the paradigm of the current RWB guidelines, which have remained unchanged for 60 years. Social and economic relevance of this thesis With tighter healthcare budgets and a shortage in hospital and rehabilitation center staff, the societal and economic relevance for an effective and cost-efficient aftercare protocol has become ever more pressing. In het Netherlands, annually, the incidence of peri- and/or intra-articular fractures of the lower extremities is more than 25,000 patients.1 These patients often suffer from sequelae and need long-term rehabilitation. The current postoperative management in surgically treated trauma patients with peri- and/or intra-articular fractures of the lower extremities is either non-weight bearing or restricted (or partial) weight bearing.2,3 According to the Arbeitsgemeinschaft für Osteosynthesefragen (AO) Principles of Fracture Management, postoperative management of peri- and/or intra-articular fractures of the lower extremities consist of non-weight bearing for 6-12 weeks, followed by partial weight bearing with a 25% increase in weight every week.2 Full weight bearing in this method will be reached per protocol after 10-16 weeks post-surgery, but in practice may take significantly more time.4,5 As described earlier in this thesis, the recommendations for the current

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