Patient compliance with postoperative lower extremity touch-down weight-bearing orders at a level I academic trauma center.
Academic Article
Overview
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.
