No abstract

Orthopedic patients are often instructed on how much weight to bear on an injured or postoperative extremity. Although specific weight-bearing instructions are given to a majority of lower-extremity orthopedic patients, the ability of patients to comply with these instructions is questioned in the medical literature. This study compared the effectiveness of new forms of clinical interventions designed to train patients on weight bearing, focusing on the use of biofeedback devices designed to offer real-time feedback to partial weight-bearing patients. Twenty healthy patients aged 20 to 30 years completed 3 interventions: (1) verbal instructions on weight bearing, (2) training with a bathroom scale, and (3) training with a biofeedback device.Patients given touchdown weight-bearing instructions (25 lb) initially bore an average of 63.57±6.24 lb when given verbal instructions. This was reduced to 44.75±5.69 lb after training with a bathroom scale (P<.001), and was further reduced to 26.2±1.57 lb with biofeedback training (P=.011). Likewise, patients given partial weight-bearing instructions (75 lb) initially bore an average of 92.28±7.85 lb. No improvement occurred with the use of a bathroom scale (at 75 lb), which showed an average of 90.82±7.19 lb (P=1.000). Training with a biofeedback device improved the average weight bearing to 69.67±3.18 lb (P=.014).Biofeedback training led to superior compliance with touchdown and partial weight-bearing instructions. Because partial weight-bearing instructions are commonly given to orthopedic patients, training with such a device may be appropriately considered.

No abstract

Biofeedback devices are increasingly used to train orthopedic patients to comply with partial weight-bearing instructions for an injured or postoperative extremity. In a previous study, the authors showed that biofeedback was effective in training young participants. However, because many partial weight-bearing orthopedic patients are of advanced age, the current study was designed to test the effect of age on partial weight-bearing training. Fifty asymptomatic participants aged between 20 and 78 years completed 3 interventions: (1) verbal instructions on weight bearing, (2) training with a bathroom scale, and (3) training with a biofeedback device. Participants given only verbal touchdown weight-bearing instructions (25 lb) initially bore an average of 61.25±4.80 lb. This was reduced to 51.50±4.47 lb after training with a bathroom scale and further reduced to 30.01±2.33 lb after biofeedback training. Likewise, participants given verbal partial weight-bearing instructions (75 lb) initially bore an average of 89.06±5.58 lb. No improvement was observed with the use of a bathroom scale (average, 88.47±4.75 lb). After training with the biofeedback device, weight bearing improved to an average of 68.11±2.46 lb. Mixed-model analysis revealed that age was not a significant predictor of compliance. However, a higher body mass index and male sex were predictive of worse compliance and heavier weight bearing. Biofeedback training leads to superior compliance to weight-bearing instructions compared with verbal instructions or training with a bathroom scale. Because partial weight-bearing instructions are commonly given to orthopedic patients, biofeedback training may be appropriately considered in any age group with similar effect.

Prognostic II.

Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

No abstract

After lower extremity fracture or surgery, physicians often prescribe limited weight bearing. The current study was performed to evaluate teaching and compliance of touch-down weight bearing (defined as 25 lb) at a level I academic trauma center. A survey was distributed to physical therapists (PTs) from the orthopedic ward to gauge their training methods and their confidence in patients' ability to comply. Patients with recommended touch-down weight bearing were then evaluated on the day of discharge and again at their first follow-up appointment using the SmartStep weight-bearing measurement device (Andante Medical Devices, Inc, White Plains, New York). Fifteen PTs completed the survey (average of 14 years in practice). Inconsistency was observed in weight-bearing teaching methods: verbal cues were used 87% of the time, tactile methods were used 41%, demonstration was used 23%, and a scale was used only 1%. Limited confidence was found in the instruction efficacy by those surveyed. Twenty-one patients were seen the day of discharge and 18 of those were seen at first follow-up. At discharge, average minimum and maximum weight bearing were 3.2 and 30.2 lb, respectively. Only 31% of steps were within an acceptable range of 15 to 35 lb. At first follow-up, average minimum and maximum weight bearing were 12.2 and 50.8 lb, respectively. Only 27% of steps were within the acceptable range. The majority of steps were less than the prescribed weight at discharge, whereas the majority of steps were greater than the prescribed weight at first follow-up. These data suggest that more uniform and effective teaching methods for prescribed weight-bearing orders are warranted assuming compliance is an important clinical objective.