Chapter 4: Chronic Health Conditions of Physical Therapy Patients 3 CCHs
By: Staff Writer Learning objectives Identify some specific health problems, symptoms as well as risk factors for each condition. Summarize common risk factors and demographic indicators of the common health problems often encountered by physical therapists. Course overview This course identifies and briefly summarizes some of the common chronic conditions and health problems encountered within patients by the physical therapist in the scope of his or her daily practice. Many of these conditions require specific knowledge about the anatomy, symptoms and considerations for care that are unique to each issue. It is also helpful for The term “arthritis,” which literally means “joint inflammation,” is an umbrella term used for more than 100 different medical conditions that are a portion of the larger category of rheumatic disease. The common thread among all of these conditions is that they affect the musculoskeletal system, especially the joints. One in five (21 percent) of U.S. adults has some form of doctor- diagnosed arthritis, according to the Centers for Disease Control and Prevention (CDC). 1 But the total number of people with arthritis is actually much greater, because many individuals do not seek medical advice for their aches and pains, so their cases are not captured in the reports from physicians. The CDC’s national household survey puts the prevalence of arthritis at one in three adults (33 percent). 2 Arthritis is currently the leading cause of disability in the United States. 3 Osteoarthritis is the most common type of arthritis, and because it is most common in people over age 60, we’ll see a huge increase in the numbers with baby boomers beginning to hit their 60s now. The number of people with doctor-diagnosed arthritis is projected to increase from 46 million in 2006 to 65 million in 2030. 1 Osteoarthritis is also referred to as degenerative, hypertrophic arthritis, or age-related arthritis. It is more common in males under age 45, but after age 45 affects more females. Physical therapy interventions, including exercise and measures to alleviate strain on affected areas, can help affected patients Anatomy and physiology Osteoarthritis occurs in the synovial joints, such as those in the knees, hips and fingers, which allow for much more movement than do the cartilaginous joints. The cartilage covering bones and joints, called articular cartilage , promotes friction-free movement and helps absorb shock. The cartilage is one of the few tissues in the body that does not have its own blood supply. Instead, the health of the cartilage is maintained by the absorption of nutrients supplied by the synovial fluid, which is secreted by a membrane that lines the joints. In addition, some joints, such as those in the shoulder and the knee, are supplemented by bursa sacs that contain fluid to help cushion the joint and reduce friction. Osteoarthritis develops when cartilage deteriorates. The biologic factors leading to the deterioration of cartilage in osteoarthritis are not entirely understood. Genetic factors are thought to be involved in about half of osteoarthritis cases in the hands and hips and a somewhat lower percentage of cases in the knee.
Discuss the unique considerations within treatment for chronic health conditions. Indicate safety concerns and practical methods that should be implemented when treating patients with these health problems. physical therapists to understand the standard treatments, as well as lifestyle adaptations that patients can implement to better manage their conditions and improve their quality of life. Understanding the fundamental needs of each patient is the foundation for providing the best care possible within the physical therapy setting. improve their range of motion and mobility and improve their quality of life. Such interventions may also help with pain relief. 15,16 The physical therapist should be aware of the anatomy and physiology related to osteoarthritis and understand the limitations and lifestyle modifications associated with this chronic condition. Figure 1: Normal Joint
OSTEOARTHRITIS
The deterioration of the cartilage usually occurs slowly over time. The cartilage begins to degenerate by flaking or forming tiny crevasses. In advanced cases, there is a total loss of the cartilage cushion between the bones of the joints. An injury to a joint or near a joint is often the starting point in the disease process. As the cartilage is worn away, the bone forms spurs (osteophytes) and fluid-filled pockets in the marrow known as subchondral cysts . As the disorder progresses, pain results from deformation of the bones and fluid accumulation in the joints. Also, bits of bone or cartilage can break off and float inside the joint space, causing more pain and damage. When the cause of osteoarthritis is unknown (in the large majority of cases) it is classified as primary or idiopathic arthritis. It is classified as secondary when it is caused by another disease or event. When young adults get osteoarthritis, for example, clinicians look for an underlying condition. Causes of secondary osteoarthritis include metabolic disorders that damage cartilage,
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