Date of Award

2016

Document Type

Scholarly Project

Degree Name

Doctor of Physical Therapy (DPT)

Department

Physical Therapy

First Advisor

Peggy Mohr

Keywords

Clinical Decision-Making; Intervertebral Disc Displacement -- therapy; Radiculopathy -- therapy; Case Reports

Abstract

Background and Purpose: Low back pain (LBP) is one of the most common and costly musculoskeletal diagnosis in America. Approximately 50% of individuals with LBP have recurrent episodes by 1 year, 60% by 2 years, and 70% by 5 years. Micro-lumbar discectomies are often performed to relieve the radiculopathy and pain associated with nerve root entrapment. The purpose of this case study was to describe the clinical decision process implemented for the post-operative assessment and intervention of a patient with a L4-5, L5-S1 discectomy and to outline the associated outcomes.

Case Description: The patient, a 26 year-old male, underwent a L4-5 and L5-S1 micro-discectomy 10 months prior to presenting to physical therapy with a diagnosis of right L4-5, S1 radiculopathy. Co-morbidities included alcohol and tobacco addiction. Prior to this episode of care, the patient attempted a multitude of care options, with no systemic relief.

Plan of Care: Multiple interventions were utilized throughout the treatment sessions due to low patient tolerance. The patient reported a decrease in pain, an increase in time for onset of pain, increased work tolerance, and a centralization of radicular symptoms.

Clinical Decision Making: Clinical decisions were based on current evidence and the International Classification of Functioning, Health and Disease (ICF) model. Outcomes were evaluated through the use of visual analog pain scale, location of radicular symptoms, and the Oswestry Disability Index.

Reflection on Practice: Using a combination of intervention resulted in the best functional outcomes for this patient. The patient's substance abuse contributed to the lack of program adherence.

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