Factors Affecting Compliance With Weight-Bearing Restriction and the Amount of Weight-Bearing in the Elderly With Femur or Pelvic Fractures

Abstract

Objective To determine the factors affecting the amount of weight-bearing during gait training in the elderly patients who underwent internal fixation after femur or pelvic fractures and how well they performed the weight-bearing restriction as directed by the physiatrist.Methods In this retrospective chart review study, we measured the amount of weight-bearing on the affected side in 50 patients undergoing internal fixation surgery and rehabilitation after femur or pelvic fracture using a force plate. Patients receiving non-weight-bearing or partial weight-bearing education were considered to perform weight-bearing restriction well when the amount of weight-bearing was <50 lb. Furthermore, regression analysis was performed to determine the effects of postoperative complications, age, cognitive function, and pain on weightbearing restriction.Results Variables affecting the amount of weight-bearing were age (r=0.581, p<0.001), weight-bearing education type (r=0.671, p<0.001), manual muscle strength of hip flexion on the non-affected side (r=-0.296, p=0.037), hip abduction (r=-0.326, p=0.021), knee extension (r=-0.374, p=0.007), ankle plantar flexion (r=-0.374, p=0.008), right hand grip strength (r=-0.535, p<0.001), Korean version of Mini-Mental State Examination (r=-0.496, p<0.001), Clinical Dementia Rating (r=0.308, p=0.03), and pain visual analog scale scores (r=0.318, p=0.024). The significant predictor of the amount of weight-bearing among these variables was age (β=0.448, p=0.001). The weight-bearing restriction adherence rate was significantly lower, at 22%, for patients aged ≥65 years as compared to 73% for those <65 years.Conclusion Age was a major variable affecting the amount of weight-bearing. Compliance with weight-bearing restriction was significantly lower in patients aged ≥65 years than in patients <65 years.

Barriers and facilitators of weight bearing after hip fracture surgery among older adults. A scoping review

“…Most reported impaired cognitive status, preoperative dementia, preoperative delirium, or postoperative delirium as barriers of weight bearing after hip fracture surgery. In contrast, one study reported no association between cognitive function and weight bearing, suggesting the decline of cognitive skills was associated with decreased peripheral nerve sensory input, which may in fact lead to increased weight bearing [106]. Indeed, the presence of cognitive impairment should not influence weight bearing orders given previous evidence for no association between cognitive impairment and adherence of weight bearing among older adults after hip fracture [38,42].…”

The Relationship Between the Meaning of Life, Psychological Well-Being, Self-Care, and Social Capital, with Depression and Death Anxiety in the Elderly Living in Nursing Homes: The Mediating Role of Loneliness

“…In some other studies, death anxiety is also reported to be high due to health problems, mobility limitations, and dependence on others (9). Depression, known as the essential factor of inability worldwide, is recognized by symptoms, such as sadness, reduced level of interest or enjoyment, feeling of guilt, sleeping or appetite disorders, feeling of tiredness, and reduced concentration level (10). The negative effects of depression on mental and behavioral states include a vast range of changes in feeling worthy, hopefulness, self-care behaviors, and quality of life (11).…”

Validation Testing of a New Crutch Tip Biofeedback Device for Prescribed Lower Extremity Weight-Bearing

“…Dabke et al8 discovered that after training both healthy subjects and patients, following a lower extremity fracture or surgery with a bathroom scale for feedback, neither group was able to accurately reproduce the prescribed weight-bearing, with the majority of subjects exceeding the target 8. Factors including patient age, weight of the patient, body mass index, type of weight-bearing education, and physical activity have also been shown to negatively affect compliance with prescribed weight-bearing 9–11…”

“…8 Factors including patient age, weight of the patient, body mass index, type of weight-bearing education, and physical activity have also been shown to negatively affect compliance with prescribed weight-bearing. [9][10][11] To instruct patients in modifying their lower extremity weight-bearing, the first clinician involved is generally the PT at the site of the orthopedic procedure, with instruction provided prior to patient discharge from the facility. To date, there have been limited means clinically available to the PT or the patient to monitor weightbearing during instruction and any activities that follow.…”