## 4 Discussion
This neutral finding is biologically plausible: the incentiviser is designed to optimise load accuracy rather than to modulate pain pathways or cardio-respiratory endurance, and the two-week follow-up is too short to translate biomechanical changes into functional gains. Comparable neutral results have been reported for load-biofeedback insole systems when pain and walking tests were evaluated within 4 weeks of surgery [10]. Longer follow-up will be required to determine whether the reduced mechanical overload observed in the intervention group accelerates functional milestones or lowers complication rates. Stratifying the primary outcome by surgery type revealed a consistent benefit of the tactile incentiviser across all diagnostic subgroups, with the largest absolute reductions in load error observed after total hip arthroplasty and femoral-shaft fracture fixation. These findings imply that tactile feedback is effective in prosthetic procedures, where postoperative pain may obscure load perception, and in fracture cases requiring strict load limitation to protect healing bone. The non-significant treatment-by-diagnosis interaction (\(p\) = 0.21) suggests that the mechanism of action is unlikely to depend on the surgical procedure itself; nevertheless, the wide confidence intervals in the smaller pelvic and ankle cohorts highlight the need for larger, diagnosis-focused trials or prospectively stratified randomisation. Such studies will clarify whether different load thresholds or feedback intensities should be tailored to specific clinical pathways. Although both groups showed improvements in pain and walking distance, these secondary outcomes did not differ significantly between groups, suggesting that the observed benefit of the incentiviser was specific to weight-bearing control rather than overall functional recovery or analgesia. The mean improvement of \(-\)10.8 kg reduced the average deviation to 2.0 \(\pm\) 3.0 kg, bringing 88% of patients within the \(\pm\)2 kg minimal clinically important difference (MCID) window defined by [PERSON] et al. (2016) [29]. Deviations over 5 kg have been associated with delayed union and hardware failure in femoral and tibial fracture fixation and inferior early functional scores after hip arthroplasty [8]. By restoring load accuracy to within the safety margin, the incentiviser is expected to reduce mechanical stress on the implant/bone interface and facilitate earlier progression to full weight bearing, both clinically relevant endpoints that cannot be captured by \(p\)-values alone. Longer follow-up studies are required to verify whether the observed biomechanical benefit translates into fewer complications and faster functional milestones. In evaluating the primary outcome of our pilot trial, which demonstrated a significant reduction in load error at discharge using plantar tactile feedback in post-operative orthopaedic patients, it is essential to compare these findings with methodologies from similar studies. For instance, the work by [PERSON] provides insights into in-shoe biofeedback devices that improve compliance in partial weight-bearing tasks in post-operative orthopaedic patients, supporting the efficacy of biofeedback in enhancing rehabilitation outcomes [34]. Additionally, [PERSON] et al. conducted a clinical trial assessing wearable sensor-based biofeedback in orthopaedic rehabilitation, which reported improvements in exercise adherence and patient outcomes during the early inpatient phase post-surgery [35]. Both studies advocate for the importance of timely and adequate biofeedback interventions in achieving rehabilitation goals within the critical early phase post-surgery [34; 35]. Our study's outcome of \(-\)10.8 kg reflects a substantial reduction; however, it is essential to recognise that while prior studies reported enhancements in outcomes, they did not specify clear numerical reductions in load error that could be directly compared to our quantified metric, thereby underscoring our study's contribution to the literature [34; 35].