Proefschrift

A protocol for permissive weight bearing during allied health therapy in pelvic and the lower extremities fractures 53 Patients and methods Basic elements of the protocol Since PWB was implemented at our rehabilitation center from 2003, and has been standard care since 2005, much experience has been gained in surgically treated trauma patients with (peri)- or intra-articular fractures of the pelvis and lower extremities. During this period, the research group has developed a PROtocol for permissive weight bearing during allied health (paraMEdical in Dutch) THerapy and Evaluation of surgically treated fractUreS (acronym: PROMETHEUS) of the pelvis and lower extremities, which consists of four basic elements, viz. a patient assessment guide, an aftercare aims identification guide, a treatment guide, and a treatment evaluation guide. Figure 5.2 shows a schematic representation of the use of the PROMETHEUS protocol. The fracture aftercare process starts by assessing the patient’s profile. Next, the generic and patient-specific treatment aims are identified, which, when combined, lead to the aftercare treatment aims. These aims are then compared with the patient’s profile descriptors, which, together with potential predictors of the outcome of the aftercare of the surgically treated fracture, may indicate (a) the feasibility of the aftercare treatment aims, (b) the estimated time frame in which the aims may be reached and (c) the intensity/dosage/weight bearing needed to achieve the aims. Treatment progress and possible complications are assessed using the treatment evaluation guide, and may lead to alteration/adjustment of the treatment plan. Patient Assessment Guide (PAG) In addition to a description/classification of fracture(s), this guide consists of a set of patient profile descriptors that have been reported in the clinical literature as being potentially useful in predicting treatment progress and outcome of individual patients during fracture rehabilitation.12-14,16 In effect, the guide serves to establish a patient profile, focusing on characteristics promoting or limiting fracture healing, therapy outcome and the occurrence or non-occurrence of complications during fracture healing. The PAG helps draw clinical conclusions on (a) the post-rehabilitation activity level to be expected, thus guiding the selection of attainable aims; (b) therapy intensity; and (c) the risk of complications occurring during the recovery process. Checking each PAG item results in a patient profile. The PAG is depicted in Figure 5.3.

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