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Characterization of compliance to weight-bearing protocols and patient weight-bearing behavior during the recovery period in lower extremity fractures

a pilot study

Lajevardi-Khosh, Arad MSa; Stuart, Ami PhDb; Ackerman, Matt MSa; Rothberg, David MDb; Kubiak, Erik MDb; Petelenz, Tomasz PhDa; Hitchcock, Robert PhDa

doi: 10.1097/BCO.0000000000000773
Innovations in Practice

Background: To promote fracture healing and limit complications, clinicians typically instruct patients with lower extremity fracture to be nonweight or partial-weight bearing or to bear weight as tolerated during the recovery period. Although this practice represents the standard of care, continuous patient compliance to weight-bearing protocols and actual patient weight-bearing progression remain unknown. This study aimed to characterize patient compliance towards weight-bearing protocols and weight-bearing progression during recovery.

Methods: Eleven patients with lower extremity fracture consented to participate in this observational study. Postoperatively, patients were instructed to follow weight-bearing protocols based upon the treating clinicians’ recommendation. Patients were fitted with an underfoot load monitor integrated into the sole of a walking boot. Continuous load data from each patient were used to quantify the number of days patients were compliant with the weight-bearing protocol.

Results: Overall, patients were unable to comply to nonweight-bearing and partial-weight-bearing protocols. Patients performed nonweight bearing and partial weight bearing only 24% and 12% of the time, respectively. Patients were most compliant (72%) to the weight bearing as tolerated protocol. Additionally, weight-bearing progressions either consistently increased (46%), remained relatively constant (27%), or remained constant initially and then suddenly increased (27%).

Conclusions: Continuous compliance data from this study indicate that patients do not comply with weight-bearing protocols. Additionally, the variety of weight-bearing progressions, with limited complications, may suggest that patients are able to self-regulate their weight bearing without compromising healing outcomes.

aDepartment of Biomedical Engineering, University of Utah, Salt Lake City, UT

bDepartment of Orthopaedics, University of Utah Hospitals and Clinics, Salt Lake City, UT

Source of Funding: This work was supported by the U.S. Department of Defense (DOD) CDMRP under Award No. W81XWH1220089 and Award No.W81XWH1220087. The opinions, interpretations, conclusions, and recommendations of this manuscript are those of the authors and are not necessarily endorsed by the Department of Defense.

Financial Disclosure: Dr. Kubiak discloses a financial relationship with zimmer Biomet and DJO Global. The potential conflict of interest is with coauthors Erik Kubiak, Tomasz Petelenz, and Robert Hitchcock who have patents related to the load monitoring technology described in this manuscript.

Correspondence to Robert Hitchcock, PhD, 36 S. Wasatch Dr, SMBB 4509, Salt Lake City, Utah Tel: +801-585-7741; fax: +801-585-536; e-mail:

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