Proefschrift

Chapter 9 142 postoperative management in surgically treated trauma patients with peri- and intraarticular fractures of the lower extremities are still more or less the same as they were during the last 60 years, without any source of evidence being given for the advice of restricted weight bearing.2 Therefore, this thesis has added quality evidence in support of the use of permissive weight bearing in surgically treated trauma patients with peri- and intra-articular fractures of the lower extremities. The results described this thesis showed that the patients in the PWB group were bearing full weight 9 weeks earlier than those in the RWB group. The effort to bear weight earlier was not at the expense of longer duration of outpatient physiotherapy. In fact, the RWB group required significantly longer outpatient physiotherapy than the PWB group, viz. 41 versus 25 hours, respectively. Furthermore, significantly more patients in the PWB group completed the rehabilitation within 26 weeks compared to the RWB group, viz. 65.2% versus 34.8%. This means that the patients returned to social life and work much sooner, underpinning the important social relevance of the findings from this thesis. Furthermore, as described in chapter 8, PWB is accompanied by less costs over a period of 26 weeks post-surgery. The total costs per patient, consisting of patient-family expenses, healthcare costs and productivity loss, were €457.51 less in the PWB group. Annually this may result in a total saving of at least €11,437,750 in the Netherlands, a number of considerable economic relevance. Target groups The results in this thesis are promising regarding a novel approach involving permissive weight bearing (PWB) in all fit surgically treated trauma patients with peri- and intraarticular fractures of the lower extremities. As there is at this point sufficient evidence that PWB is in comparison to RWB sufficiently both effective in terms of functional/ health-related outcomes and cost-effective, we are advocating that all surgically treated trauma patient with peri- and intra-articular fractures of the lower extremities may be treated with the PWB protocol. The current, non- or restricted weight bearing guidelines should in our opinion be replaced by PWB protocols. To reach out the implementation of the PWB protocol, the surgeons should endorse the PWB protocol. With this thesis, we hope to change the mindset of both orthopedic and trauma surgeons to use the PWB protocol. Furthermore, the physical therapist has to be facilitated in carrying out the PWB protocol as decribed in chapter 5 by 1) Creating easily understandable therapeutic flow charts for treatment of patients with the PWB protocol 2) Educating junior physical therapists early on in their training in PWB . Activities and products The work in this thesis may result in various activities and products. First and foremost, it will result in the increase of accredited educational activities, both webinars and

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