Proefschrift

Effectiveness of PWB in surgically treated trauma patients with peri- and intra-articular fractures of the lower extremities 93 being able to bear full weight on their affected leg much sooner, with a better ADL and quality of life, compared to those who followed the usual RWB regimen. No significant differences between the two treatment regimens were found in either postoperative complication rates or pain levels. Patients’ self-perceived outcome levels were significantly better among patients who followed the PWB protocol than among those who followed the RWB protocol. This study found a general improvement in ADL (LEFS) and quality of life (SF-12) for both groups during the 26-week rehabilitation period. In our total population, the mean LEFS 26 weeks post-surgery was 55.2 (14.3). This is in line with earlier studies, which found similar levels of ADL in trauma patients after surgery of the lower extremities.23-25 The mean quality of life for the total population in our study was also in the same range as that reported by other studies.26,27 Despite the early PWB regimen, the recorded pain levels during the 26-week rehabilitation period were higher in the RWB group than in the PWB group, which could be due to the consequences of immobilization.2 In our study 56.6% of the patients in the RWB group were already bearing full weight within 12 weeks, in contrast to the standard protocol of 12 weeks non-weightbearing or partial weight bearing.1 Earlier studies also reported that one-third of patients (due to e.g. cognitive impairment in older patients to follow instructions) did not comply with a non-weight-bearing or restricted weight bearing regime.5,6 Despite the willingness to comply, patients often do not follow the weight-bearing restrictions and increase their weight bearing as fracture healing progresses.6 This is also in line with our data on weight bearing, as measured with the Moticon insoles. These measurements showed that there was no significant difference in mean weight bearing between the RWB and PWB groups. The difference in peak loading was nearly significant between the RWB group and PWB group: p=0.05. 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%. Our study found that there was no significant difference in postoperative complications between the PWB group and the RWB group. One of the key objections often raised against early weight bearing is the possibility of fracture displacement.28 On the other hand, it has often been stated that early weight bearing does not entail an undue risk of postoperative complications.2,3,12,13,29 These two views are contradictory,

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