Ask a patient discharged on partial weight-bearing how much weight they are putting through the leg and you will get a shrug. The instruction is meaningless without a quantity and a way to feel it, which is why adherence to it is poor and why some fixations fail for reasons that never appear in the operation note.
Give the number in kilograms rather than as a fraction of body weight, because the patient can act on 20 kg and cannot act on one-third. Then train it: stand the patient with the operated foot on a bathroom scale, let them press until the dial reads the target, and have them repeat it until they recognise the sensation. Physiotherapy should do this before discharge and the family should watch.
Write the same number on the discharge summary, in the physiotherapy plan and on a card the patient keeps. And set the review date at which it changes, because an instruction with no end date is either abandoned early or followed for months after it should have stopped.
- Convert the restriction to kilograms and write that number, not a fraction.
- Train it against a bathroom scale before discharge, with a relative present.
- Put the same figure on the discharge summary, the physiotherapy plan and a patient-held card.
- State the date the restriction changes, not just the restriction.
- Ask the patient to demonstrate at follow-up rather than asking whether they have complied.
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