Date of Award

January 2013

Document Type

Open Access Thesis

Degree Name

Medical Doctor (MD)



First Advisor

Jonathan Grauer

Subject Area(s)

Biomechanics, Medicine


Partial weight-bearing (PWB) instructions are commonly given to orthopaedic patients. However, the ability of patients to comply with these instructions is poorly defined. Recent advances in technology have created biofeedback devices capable of offering real-time feedback to patients given PWB instructions. These devices could potentially increase patient compliance with PWB instructions following orthopaedic surgery. This thesis was designed to evaluate the effectiveness of modulating partial weight-bearing using the SmartStepTM biofeedback device.

Fifty asymptomatic subjects aged 21-72 years were given three educational interventions designed to train them to limit weight-bearing on a lower extremity: verbal instructions, training with a bathroom scale, and training with a biofeedback device. Weight-bearing was measured after each activity to determine the effectiveness of biofeedback as compared to other clinical teaching methods. Additionally, another 14 subjects were given biofeedback training and retention was measured over a 24-hour period to assess retention of biofeedback training.

Subjects given only verbal touch down weight-bearing instructions (25lbs) initially bore an average of 61.25± 4.80lbs (average ± standard error). This was reduced to 51.50 ± 4.47lbs after training with a bathroom scale and was further reduced to 30.01 ± 2.33lbs after biofeedback training.

Likewise, subjects given verbal partial weight-bearing instructions (75lbs) initially bore an average of 89.06 ± 5.58lbs. There was no improvement with the use of a bathroom scale, with an average of 88.47 ± 4.75lbs. After training with a biofeedback device, weight-bearing improved to an average of 68.11 ± 2.46lbs. Mixed model analysis found age was not a significant predictor of subject compliance. However, higher BMI and male gender were predictive of heavier weight-bearing.

Additionally, subjects in the retention study initially bore 20.4 ± 2.12 lbs (average ± standard error) after biofeedback training. Retention tests during the 24 hour period showed no significant difference from the original testing, with 2-4 hour retention of 19.98 ± 4.75 lbs; 6-8 hour retention of 25.07 ± 6.60 lbs; and 24 hour retention of 21.75 ± 4.58 lbs.

Biofeedback training leads to superior compliance with touch down and partial weight-bearing instructions as compared to verbal instructions or training with a bathroom scale. Compliance was negatively affected by BMI and male gender, but not age. Additionally, biofeedback training shows retention up to 24-hours. As partial weight-bearing instructions are commonly given to orthopaedic patients, training with such a device may be appropriately considered.


This is an Open Access Thesis.

Open Access

This Article is Open Access