Inter-rater reliability of affected-side weight bearing ratio measurement in postoperative patients with proximal femoral fractures.

Ten patients at a single hospital. The authors say reliability was tested in only one institution and that this limits how far the result can be generalised. The therapists measuring were not the same on each of the three days; three of the six took part on any one day, which the authors acknowledge may have influenced the reliability estimates. The sample size calculation assumed five raters but only three measured on any given day, so the number of raters did not fully match the plan. Patients scoring 20 or lower on the revised Hasegawa Dementia Scale were excluded, so nothing here tells you whether the measurement holds up in patients with cognitive impairment, who are common after hip fracture. Fracture type was not recorded, so the effect of how severe the fracture was on weight bearing and on standing tolerance is unknown. The study checked only whether the measurement is consistent. The authors state plainly that judging whether the weight-bearing ratio predicts walking or discharge was not the purpose. The test requires the patient to stand and hold parallel bars and to follow an instruction to load the leg, so patients who cannot stand with support were not represented.

The authors state that the study had no financial support and declare no conflicts of interest.

Do not read this as evidence that the weight-bearing ratio predicts anything. The study only checked whether two therapists get the same number, and the authors say so themselves. It also cannot tell you the measure is this dependable in your own hospital: it rests on ten patients in one institution, only three therapists measured on any one day, and patients with poorer cognition were excluded.