Is It Possible to Train Patients to Limit Weight Bearing on a Lower Extremity?

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.

Is the AO guideline for postoperative treatment of tibial plateau fractures still decisive? A survey among orthopaedic surgeons and trauma surgeons in the Netherlands

“…It should be kept in mind that another complicating factor could be lack of patient compliance with prescribed rehabilitation aftercare [14, 15]. A number of studies reported that patients often exceeded the prescribed level of partial weight bearing, even when self-reported compliance was high [16].…”

Rehabilitation of Lower Extremity Trauma: a Review of Principles and Military Perspective on Future Directions

“…In addition to these concerns, the most notable issue with restricted weight bearing is poor patient compliance. Patients consistently exceed the allowed "weight" in partial weight bearing, despite believing they are compliant [33,36]. Other methods of retraining such as the use of a scale, tactile hand under foot, verbal cues, and auditory biofeedback have also failed to demonstrate efficacy [37,38].…”

Biofeedback in Partial Weight Bearing: Usability of Two Different Devices from a Patient’s and Physical Therapist’s Perspective

“…These devices use different technology to measure WB and to provide real-time feedback. Thereby, SmartStep has already been used in several studies on PWB [10,14–16]. The recently developed OpenGo Science does not interfere with natural gait by using insoles without external modules attached to the body.…”