Date of Award

2016

Document Type

Scholarly Project

Degree Name

Doctor of Physical Therapy (DPT)

Department

Physical Therapy

First Advisor

Michelle LaBrecque

Keywords

Anxiety; Arthroplasty, Replacement, Knee -- rehabilitation; Scoliosis; Case Reports

Abstract

Background and Purpose: Osteoarthritis (OA) is the largest source of physical disability in the United States and the joint most commonly affected by OA is the knee. Total knee arthroplasty (TKA) is frequently implemented as a treatment for knee OA There is research that anxiety affects the patient's outcomes following total joint arthroplasty, but nothing to suggest how to specifically manage it. The purpose of this scholarly report is to discuss the physical therapy (PT) of a patient post TKA and how modifications to PT intervention were needed due to other medical and emotional issues.

Case Description: Patient was a 56 year old female presenting to outpatient PT five days post left total knee arthroplasty. Left knee AROM on initial evaluation was lacking 10° of extension with 80° of flexion. Patient's other medical conditions included a severe "S" shaped scoliosis. Patient was overly emotional and reported that she had anxiety about falling behind in her rehabilitation.

Intervention: Frequency of outpatient PT was twice a week for eight weeks. A heavy focus of the patient's intervention was placed on regaining left quadriceps strength as quadriceps weakness is a primary impairment in individuals with TKA. Another focus of intervention was hip abductor strengthening to help stabilize the pelvis during gait and stair ambulation.

Outcomes: Patient was seen for a total of 11 sessions over five weeks with increased left knee AROM and strength, and an improved patient-therapist relationship. Patient's anxiety and back pain secondary to scoliosis continued throughout PT sessions. Intervention adaptations, frequent verbal reassurance, and an increased amount of patient education were provided and goals were met by the time of her discharge from PT.

Discussion: Patient had overall positive outcomes post left TKA. More attention was placed on the positives of patient's rehabilitation to keep her anxiety reduced. Modifications of positioning were utilized to minimize back pain secondary to her scoliosis. Further research and protocols including adaptations for patients with increased anxiety and severe scoliosis are needed.

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