Journal of Rehabilitation Medicine 51-4inkOmslag

J Rehabil Med 2019; 51: 290–297 ORIGINAL REPORT A PROTOCOL FOR PERMISSIVE WEIGHT-BEARING DURING ALLIED HEALTH THERAPY IN SURGICALLY TREATED FRACTURES OF THE PELVIS AND LOWER EXTREMITIES Guido MEYS 1 *, Pishtiwan H. S. KALMET, MD 2 *, Sebastian SANDULEANU, MD 2 , Yvette Y. VAN HORN, MD 1 , Geert Jan MAAS, MSc 1 , Martijn POEZE, MD, PhD, MSc 2,4 , Peter R. G. BRINK, MD, PhD 2 and Henk A. M. SEELEN, PhD 3,5 From the 1 Adelante Rehabilitation Centre, Department of Amputation, Traumatology and Orthopaedics, Hoensbroek, 2 Maastricht University Medical Centre, Department of Trauma Surgery, Maastricht, 3 Adelante, Centre of Expertise in Rehabilitation and Audiology, Hoensbroek, 4 Nutrim School for Nutrition, Toxicology and Metabolism, Maastricht University, Maastricht and 5 Maastricht University, Research School CAPHRI, Department of Rehabilitation Medicine, Maastricht, The Netherlands * These authors contributed equally to this publication Objective: To optimize rapid clinical recovery and restoration of function and functionality, permissive weight-bearing has been designed as a new after- care mobilization regimen, within the upper boun- dary of the therapeutic bandwidth, yet safe enough to avoid overloading. The aim of the present paper is to describe a comprehensive protocol for permissive weight-bearing during allied health therapy and to report on the time to full weight-bearing, as well as the number of complications, in patients with surgi- cally treated fractures of the pelvis and lower extre- mities undergoing permissive weight-bearing. Patients and methods: This study included surgically treated trauma patients with (peri)- or intra-arti- cular fractures of the pelvis and lower extremities. A standardized permissive weight-bearing protocol was used for all patients. Time to full weight-bearing and number of complications were recorded. Results: This study included 150 patients, 69% male, with a median age of 48 years (interquartile range (IQR) 33.0, 57.0). The median time to full weight bearing was 12.0 weeks (IQR 6.8, 19.2). The compli- cation rate during rehabilitation was 10%. Conclusion: The permissive weight-bearing protocol, as described, might be beneficial and has potential to be implemented in trauma patients with surgically treated (peri)- or intra-articular fractures of the pel- vis and lower extremities. Key words: surgically treated fractures; rehabilitation; post- operative period; aftercare; guidelines; permissive weight- bearing. Accepted Jan 30, 2019; Epub ahead of print Feb 15, 2019 J Rehabil Med 2019; 51: 290–297 Correspondence address: Pishtiwan Hassan Shaker Kalmet, Maastricht University Medical Center, Department of Traumatology, P. Debyelaan 25, 6229 HX Maastricht, The Netherlands. E-mail: pishtiwan.kalmet@ mumc.nl A plethora of evidence is available about open re- duction and internal fixation procedures in trauma patients with (peri)- or intra-articular fractures, as well as about the processes involved in bone healing (1, 2). However, the subsequent rehabilitation treat- ment, or early aftercare, has been less systematically LAY ABSTRACT Aftercare in surgically treated trauma patients with frac- tures of the pelvis and lower extremities has remained largely unchanged during the past 60 years. To optimize rapid clinical recovery and the restoration of function and functionality, permissive weight-bearing has been designed as a new aftercare mobilization regime, within the upper boundary of the therapeutic bandwidth, yet safe enough to avoid overloading. The aim of the pre- sent paper is to describe a comprehensive protocol for permissive weight-bearing during allied health therapy and to report on both the time to full weight-bearing and the number of complications in patients with surgi- cally treated fractures of the pelvis and lower extremi- ties who undergo permissive weight-bearing. documented and is often based on empirical, implicit knowledge of individual medical or allied health therapists, acquired throughout many years of clinical practice. No formal evidence-based guidelines are available on the aftercare of surgically treated fractures. In view of this lack of evidence, many orthopaedic and trauma surgeons tend to advise conservatively with regards to weight-bearing in rehabilitation, and hold on to the prevailing dogmas, i.e. recommending time- contingent progression of weight-bearing. In addition, even with specific advice from specialists, patients may not always be committed to complying with non- weight-bearing advice (3–5). It is remarkable that the recommendations for aftercare in patients surgically treated for fractures are still more or less the same as 60 years ago, without any sources of evidence being given for the advice (2, 6). Fracture healing is a physiologically complex pro- cess (7). The pace at which bone formation processes take place, together with the aftercare treatment pro- vided, determine what progression of weight-bearing may be applied. Weight-bearing dosage is often quan- tified in terms of percentage of body weight, or expres- sed in more general terms, such as non-weight-bearing/ partial weight-bearing/full weight-bearing, without the therapist knowing which weight is actually borne at the level of the osteosynthesis and fracture during This is an open access article under the CC BY-NC license. www.medicaljournals.se/jrm doi: 10.2340/16501977-2532 Journal Compilation © 2019 Foundation of Rehabilitation Information. ISSN 1650-1977

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