## 4 Discussion
Our findings add to the growing body of evidence advocating for biofeedback as a crucial adjunct in rehabilitating post-operative orthopaedic patients, suggesting further exploration into optimising feedback modalities to maximise patient recovery. Because the incentiviser is mechanical, material costs are <EUR 5 per pair, and no batteries, electronics, or maintenance contracts are required. Fabrication can be delegated to the orthotic workshop or physiotherapy aide; fitting and static calibration take <10 min once staff receive a brief (\(\approx\)1 h) hands-on tutorial covering threshold adjustment and patient education. Integration into routine practice is simplest during the first assisted ambulation session, replacing the \"bathroom-scale\" drill that most wards already perform but rarely repeat. Anticipated barriers include limited shoe space in patients with rigid post-operative dressings, nurses' concerns over skin irritation, and the absence of a reimbursement code; all can be mitigated by stocking three inside sizes, adding a thin felt cover for fragile skin, and incorporating the device within the standard physiotherapy tariff. Furthermore, the multifaceted approach of the study acknowledges the limitations inherent in previous research. Past investigations have often been constrained by small, heterogeneous patient populations and short-term follow-up periods, thereby limiting the generalizability of their findings to diverse clinical contexts [4; 6]. Our study seeks to overcome these barriers by providing a more extended evaluation of the weight-bearing sensitivity enhancer's performance over a longer duration and across a broader spectrum of lower limb pathologies. By doing so, we hope to offer stronger evidence regarding the long-term benefits of continuous biofeedback in enhancing partial weight-bearing accuracy and accelerating postoperative recovery. This investigation was conceived as a pilot, single-centre trial, and the sample size, although adequately powered for the primary outcome, was too small to detect diagnosis-specific effects, infrequent adverse events, or longer-term clinical sequelae. Participants were recruited from a single orthopaedic ward with relatively homogeneous postoperative protocols; therefore, the findings may not generalise to other rehabilitation settings, patients with substantial comorbidities, or those managed without continuous professional supervision. Outcomes were collected only at discharge (-14 days), so the durability of the load-accuracy improvement and its impact on gait symmetry, pain, and bone healing beyond the inpatient phase remain unknown. Because patients and therapists cannot be blinded to allocation, behavioural and placebo effects, or greater therapist attention in the intervention arm, they cannot be completely ruled out. Finally, the mix of surgical indications (arthroplasty, internal fixation, osteotomy) introduces clinical heterogeneity that may have diluted or inflated the observed treatment effect. Future multicentre trials with longer follow-up and stratified analysis are needed to confirm these results and to evaluate cost-effectiveness and adherence in home-based use. A further limitation is the absence of placebo control conditions. Although outcome assessors were blinded, patients and therapists were aware of device allocation, and the additional tactile stimulus may have enhanced attention or motivation independently of load accuracy. Future trials should incorporate a sham insole with inert buttons to control expectation and contact time. Another limitation of the study is the lack of clinical outcome data. In summary, integrating an accessible, low-cost biofeedback device into rehabilitation protocols represents a promising evolution in the management of partial weight-bearing. This study is positioned within an emerging body of the literature that increasingly recognises the limitations of traditional static methods and advocates for dynamic, real-time solutions that improve load perception and enhance overall functional recovery.