Weight-bearing status: what non-weight-bearing and partial orders mean for a ride

What a weight-bearing order says

A weight-bearing order tells the patient how much of their body weight an injured or operated leg may carry. The Veterans Health Administration’s orthopaedic handling algorithms, reprinted in NIOSH’s 2009 safe patient handling curriculum, put it plainly: the physician prescribes the status from how much weight the bones and joints can safely take, and going past it may harm the patient. It is one of several limits a surgeon may set, and the others are covered in riders after surgery.

The same algorithms define the two orders that matter most for a ride:

• Non-weight-bearing. The patient cannot put weight through both legs, or must not. A rider with that order cannot stand.
• Partial weight-bearing. Limited weight on one leg with full weight on the other, or partial weight through both. The algorithms count a patient who can bear weight on one leg only in this group, which is where a rider with a non-weight-bearing order on a single leg lands.

With a full weight-bearing order, the leg may carry the rider’s whole weight. The American Academy of Orthopaedic Surgeons says a patient whose broken hip is treated with a hip replacement can usually bear full weight right away, while after internal fixation the doctor decides whether and how much weight is allowed. Its ankle fracture page warns that putting weight on too early can let the fracture slip out of place and heal badly or not at all.

What the order changes on the ride

The order tells the driver which moves are off the table. Three moves need checking:

• The van step. A van step works like a stair, and the Academy calls stairs on crutches a job that takes both strength and flexibility. It says never to climb stairs with a walker. Federal ADA rules let a standing rider board on the lift, and preventing rider falls covers that and step stools.
• The transfer. For a patient in a cast or splint who can stand on one leg, the VA algorithm allows a stand-and-pivot with one or two caregivers, a pivot disk, or a powered stand-assist lift. A rider who may not bear weight on either leg is a candidate for a transfer board if they have arm strength, or a lift if not. Safe passenger transfers covers each method.
• The seat. MedlinePlus tells hip replacement patients to get into a car from street level rather than from a curb, and not to use car seats that are too low. Legs that must stay straight or raised are covered in riders after surgery.

Which ride level fits a non-weight-bearing rider

Pick the level by what the rider can do with the order in place, not by the injury itself. Payers spell out the cases that move a rider up:

• Georgia’s NEMT manual allows more than a minibus for a member whose disabling condition requires a walker, cane, crutches, or brace and who cannot use a minibus, taxi, or public transportation.
• Massachusetts covers wheelchair van service, under 130 CMR 407.471, for members who need to be carried up or down stairs because they cannot walk them or cannot walk without two people helping.
• Medi-Cal names riders in a spica cast among its examples for litter van service.

A rider who is non-weight-bearing on both legs cannot walk to the vehicle, so the trip is non-ambulatory: a wheelchair van if they can sit for the trip, a stretcher if they cannot.

Getting the order right at booking

1. Which leg, and what exactly does the order say: no weight, partial, or full?
2. What does the rider use: crutches, a walker, a wheelchair, a cast, or a boot?
3. Are there steps at home or at the clinic, and is there an elevator?
4. Can the rider get into a car seat safely, and from street level?
5. When is the next visit that could change the order?

Therapy after a fracture or joint surgery can run for weeks. In HealthRide those visits can be set up as recurring trips, and the wheelchair need on each one is matched to a van with a lift.