Proefschrift

Chapter 6 74 Patients and methods This retrospective cohort study included surgically treated trauma patients with tibial plateau fractures at Maastricht University Medical Center+, the Netherlands, who underwent aftercare according the PWB or a RWB protocol between 2005-2015. In the PWB group, the patients were discharged to a rehabilitation center, where they were treated according the PWB protocol. Since 2003 PWB was gradually implemented and became standard care in our rehabilitation center from 2005. The fracture aftercare process starts by assessing the patient’s profile. Next, the generic and patient-specific treatment goals are identified, which, when combined, lead to the aftercare treatment aims. These aftercare treatment aims are then contrasted to the patient’s profile descriptors, which, together with potential predictors of surgically treated fracture aftercare outcome, may give insight into a) the feasibility of the aftercare treatment aims; b) the estimated time frame in which the aftercare treatment aims may be reached; and c) the intensity/dosage/weight bearing needed to achieve the aftercare treatment aims. The increase in weight bearing is not based on a fixed percentage per week: weight bearing is gradually increased, based on the patient’s clinical presentation and with special attention to the quality of gait. Other key elements include body awareness and safe patient handling and moving algorithms, which are also considered to be key factors for successful treatment. The program involves multidisciplinary cooperation with surgeons, rehabilitation physicians and physical therapists, which is considered paramount to safely use the PWB protocol. The patients included in the protocol suffered from two or more fractures (upper and lower extremity fractures) and therefore needed more aftercare. The patients in the RWB group were discharged to their own home. They received passive exercise to maintain the muscles and the knee joint supported by a physical therapist, as prescribed by the surgeon. All data in the study were collected from the electronic medical records by one researcher. Demographics of patients included age, gender and the presence of other fractures at the same time. Primary outcome measures included the patient- reportedquestionnaire after at least 1-year follow up; 1) Quality of life measured with the Short Form 12 (SF-12).20 The SF-12 consists of 12 items that assess 8 dimensions of health: physical functioning, rolephysical, bodily pain, general health, vitality, social functioning, role-emotional and mental health. The SF-12 measures various aspects of physical and mental health from which physical and mental summary scores can be calculated. 2) The intensity of pain measured with the VAS scale, (0 is no pain and 10 is worst pain).21

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