Raaben Marco, Holtslag Herman R, Leenen Luke P H, Augustine Robin, Blokhuis Taco J
Department of Surgery, University Medical Center Utrecht, Heidelberglaan 100, 3508 GA Utrecht, The Netherlands.
Department of Rehabilitation Medicine, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
Gait Posture. 2018 Jan;59:206-210. doi: 10.1016/j.gaitpost.2017.10.022. Epub 2017 Oct 20.
Individuals with lower extremity fractures are often instructed on how much weight to bear on the affected extremity. Previous studies have shown limited therapy compliance in weight bearing during rehabilitation. In this study we investigated the effect of real-time visual biofeedback on weight bearing in individuals with lower extremity fractures in two conditions: full weight bearing and touch-down weight bearing.
11 participants with full weight bearing and 12 participants with touch-down weight bearing after lower extremity fractures have been measured with an ambulatory biofeedback system. The participants first walked 15m and the biofeedback system was only used to register the weight bearing. The same protocol was then repeated with real-time visual feedback during weight bearing. The participants could thereby adapt their loading to the desired level and improve therapy compliance.
In participants with full weight bearing, real-time visual biofeedback resulted in a significant increase in loading from 50.9±7.51% bodyweight (BW) without feedback to 63.2±6.74%BW with feedback (P=0.0016). In participants with touch-down weight bearing, the exerted lower extremity load decreased from 16.7±9.77kg without feedback to 10.27±4.56kg with feedback (P=0.0718). More important, the variance between individual steps significantly decreased after feedback (P=0.018).
Ambulatory monitoring weight bearing after lower extremity fractures showed that therapy compliance is low, both in full and touch-down weight bearing. Real-time visual biofeedback resulted in significantly higher peak loads in full weight bearing and increased accuracy of individual steps in touch-down weight bearing. Real-time visual biofeedback therefore results in improved therapy compliance after lower extremity fractures.
下肢骨折患者通常会被告知患侧下肢的负重程度。以往研究表明，康复期间患者在负重方面的治疗依从性有限。在本研究中，我们调查了实时视觉生物反馈在两种情况下对下肢骨折患者负重的影响：完全负重和触地负重。
使用动态生物反馈系统对11名下肢骨折后完全负重的参与者和12名触地负重的参与者进行了测量。参与者首先行走15米，此时生物反馈系统仅用于记录负重情况。然后在负重过程中提供实时视觉反馈，重复相同的方案。参与者由此能够将其负荷调整到期望水平并提高治疗依从性。
在完全负重的参与者中，实时视觉生物反馈使负荷从无反馈时的50.9±7.51%体重显著增加至有反馈时的63.2±6.74%体重（P = 0.0016）。在触地负重的参与者中，施加的下肢负荷从无反馈时的16.7±9.77千克降至有反馈时的10.27±4.56千克（P = 0.0718）。更重要的是，反馈后个体步幅之间的差异显著减小（P = 0.018）。
下肢骨折后动态监测负重情况表明，无论是完全负重还是触地负重，治疗依从性都较低。实时视觉生物反馈使完全负重时的峰值负荷显著提高，并提高了触地负重时个体步幅的准确性。因此，实时视觉生物反馈可提高下肢骨折后的治疗依从性。
