Real-time visual biofeedback during weight bearing improves therapy compliance in patients following lower extremity fractures

Background: 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. Methods: 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 15 m 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. Results: 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 +/- 9.77 kg without feedback to 10.27 +/- 4.56 kg with feedback (P=0.0718). More important, the variance between individual steps significantly decreased after feedback (P=0.018). Conclusions: 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.