Orthopedic Inpatients’ Ability to Accurately Reproduce Partial Weight Bearing Orders

Abstract

Partial weight bearing is often prescribed for patients with orthopedic injuries. Patients’ ability to accurately reproduce partial weight bearing orders is variable, and its impact on clinical outcomes is unknown. This observational study measured patients’ ability to reproduce partial weight bearing orders, factors influencing this, patients’ and physiotherapists’ ability to gauge partial weight bearing accuracy, and the effect of partial weight bearing accuracy on long-term clinical outcomes. Fifty-one orthopedic inpatients prescribed partial weight bearing were included. All received standard medical/nursing/physiotherapy care. Physiotherapists instructed patients in partial weight bearing using the hand-under-foot, bathroom scales, and/or verbal methods of instruction. Weight bearing was measured on up to 3 occasions during hospitalization using a force-sensitive insole. Factors that had the potential to influence partial weight bearing accuracy were recorded. Patients and their physiotherapists rated their perception of partial weight bearing accuracy. Three-month clinical follow-up data were retrieved from medical records. The majority of patients (72% or more) exceeded their target load, with mean peak weight bearing as high as 19.3 kg over target load (285% of target load). Weight bearing significantly increased over the 3 measurement occasions (P<.001) and was significantly associated with greater body weight (P=.04). Patients and physiotherapists were unable to accurately gauge partial weight bearing accuracy. The incidence of clinically important complications at 3 months was 9% and not significantly associated with partial weight bearing accuracy during hospitalization (P≥.45). Patients are unable to accurately reproduce partial weight bearing orders when trained with the hand-under-foot, bathroom scales, or verbal methods of instruction.

Outcome of patients after lower limb fracture with partial weight bearing postoperatively treated with or without anti-gravity treadmill (alter G®) during six weeks of rehabilitation – a protocol of a prospective randomized trial

“…Thus it could be possible that during training in the treadmill with 20 kg body weight partial loading might be higher than 20 kg. Several studies showed that the majority of patients could not reproduce accurately partial weight bearing and exceeded their target load with about 20 kg over target load [22–24]. Hence we accepted a possible inaccuracy of the treadmill since it is known that patients cannot put partial weight bearing of 20 kg into practice.…”

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

“…However, these methods do not represent dynamic activities (e.g. walking) and are not accurate in training patients to comply with partial weight-bearing (PWB) instructions [5–9]. Previous research shows that it is difficult for patients to comply with WB instructions [1,5,7,9–13].…”

“…walking) and are not accurate in training patients to comply with partial weight-bearing (PWB) instructions [5–9]. Previous research shows that it is difficult for patients to comply with WB instructions [1,5,7,9–13]. Reasons for non-compliance include [1] the difficulty to judge the load placed on the lower-limb, and [2] the use of inadequate training methods to achieve controlled PWB [1,7,11,13].…”

Biofeedback in partial weight bearing: usability of two different devices from patient's and physical therapist's perspective

“…However, these methods do not represent dynamic activities (e.g. walking) and are not accurate in training patients to comply with partial weight-bearing (PWB) instructions [5][6][7][8][9]. Previous research shows that it is difficult for patients to comply with WB instructions [1,5,7,[9][10][11][12][13].…”

“…walking) and are not accurate in training patients to comply with partial weight-bearing (PWB) instructions [5][6][7][8][9]. Previous research shows that it is difficult for patients to comply with WB instructions [1,5,7,[9][10][11][12][13]. Reasons for non-compliance include [1] the difficulty to judge the load placed on the lower-limb, and [2] the use of inadequate training methods to achieve controlled PWB [1,7,11,13].…”