providing a cumulative upper score of 80 indicating better functional status. The minimal detectable change for the LEFS has been estimated to be 9 points. The benefits of using the LEFS are that it takes roughly 5 minutes to administer and that there is no cost associated with its use (Kennedy et al., 2011). Physical performance measures A drawback of patient-reported outcomes for the assessment of activity limitations is that they rely on the patient’s assessment of his or her functional ability. When someone no longer engages in an activity, whatever the reason, the self-reported ability to perform that activity may be overestimated or underestimated. For this reason, performance-based measurement (also known as physical performance measures) may also be useful (Kennedy et al., 2011). Similar to the patient self-reported outcomes measures some physical performance measures are more frequently seen in a research setting and some are more applicable in the clinical setting. Examples of physical performance measures are the timed up and go (TUG) test, the sit to stand in 30 seconds test, and the 6-minute walk test (6MWT). With the exception of the 6MWT, all the previously mentioned tests can be completed in 2 to 3 minutes in the clinical setting, which facilitates their use in the day to day clinical assessment of patient progress. Conclusion After THA, patients can generally expect to return to the performance of most previous activities with full weight bearing once healing has taken place and rehab is complete. With the movement toward enhanced preoperative preparation, which encompasses increased education and provision of preoperative PT (Stambough et al., 2015), and changes in surgical approaches used and where surgery is performed (Aynardi et al., 2014; Chen et al., 2013), the assumption that all patients should have optimal outcomes is appropriate. However, patients can find it difficult to achieve high-level activities without the help of skilled PT practitioners. It is evident that even at 1 year following surgery symmetrical lower limb motion and functional abilities have not returned to optimal levels (Agostini et al., 2014; Kennedy et al., 2011). Physical therapists are key components of the successful THA experience, and comprehensive rehabilitation is critical to decrease postoperative complications, restore flexibility and strength, and enable independence with activities of daily living. Much of what is known about patient Mrs. F.G. is a retired school teacher who underwent an elective left THA 2 days ago after enduring left hip pain and limited hip motion for several years. She had delayed undergoing the surgery because she was taking care of her elderly mother who passed away 3 months ago. After reviewing Mrs. F.G.’s medical chart ahead of evaluating her in her hospital room, the physical therapist noticed that the patient has a history of osteoporosis and diabetes and that her plan is to go to a rehab setting for 2 weeks before returning home. Entering her room the physical therapist sees that Mrs. F.G. is reclined in bed and has not eaten any of her breakfast. She reports that the pain around her hip is 8/10 where 10 is the worst imaginable pain. She does not remember receiving any pain medications that morning since she woke. She did have nausea yesterday, and the anesthesiologist has been working on adjusting her medications to allow her to be more comfortable. Questions 1. What would the physical therapist’s first action be in the care of Mrs. F.G.? 2. How would the physical therapist best measure strength in the lower limbs before having Mrs. F.G. stand at the side of the bed?
The TUG test is a test where the time taken in seconds for a subject to rise from a standard chair, walk at a safe pace to a cone 8 feet away and return to the sitting position is recorded. This has been shown to be a reliable test for individuals undergoing THA (Okoro et al., 2016). The sit to stand in 30 seconds test records the maximal number of times a subject can rise with arms crossed over his or her chest, from a standardized chair in 30 seconds. This test may be appropriate for individuals who have a very limited ability to ambulate. It is designed to reflect the ability to perform activities of daily living (Okoro et al., 2016). The 6MWT reflects the distance covered in a level corridor over a 6-minute time period. It can be used with patients following THA but it might be more challenging to use in the acute postoperative time period when the patient is still using an assistive device. Outcomes measures allow for the identification of meaningful change in a patient’s status that can help justify the role of PT in the rehabilitation program of a patient who has undergone a THA. What is becoming clear is that neither patient-reported outcomes nor physical performance outcomes alone capture the entire functional ability of the patient, and there has been a movement toward using both forms of outcome to best capture a patient’s status (Heiberg et al., 2013; Kennedy et al., 2011). dissatisfaction following THA is not related to the development of major complications. Instead, satisfaction correlates strongly with relief of pain, restoration of function, and success in meeting patient expectations (Anakwe et al., 2011). Therapists help to motivate, educate, and rehabilitate patients so they may improve their quality of life with the new hip. Although evidence-based practice is growing and new research findings are being implemented every day, evidence showing the efficacy of PT intervention for this growing population of patients is still relatively sparse. More research is needed to demonstrate the efficacy of treatment techniques that can be objectively measured and shared to enhance the ability of therapists to facilitate the smooth and rapid recovery process for their patients with total hip replacements. Physical therapists need to increase their use of both patient-reported outcomes and physical performance outcomes measures in order to be able to provide evidence of the role of the physical therapist in the overall THA process. 3. Mrs. F.G. has not had her catheter removed yet. What would the physical therapist’s ambulation goal be on postoperative day one? 4. Due to continued nausea Mrs. F.G. has not been very motivated to ambulate and required considerable encouragement. On postoperative day two, she reports that her left calf is hurting from the way she slept overnight. What might the physical therapist in fact be concerned about in the case of this patient? Answers 1. Based on Mrs. F.G.’s complaints of pain it would be appropriate to speak with her nurse to establish when the patient last received her pain medications. It is possible that the patient may have forgotten that she was recently given her medications. If the medications were given, and the pain is 8/10 this then warrants further investigation before starting the PT evaluation. If however the patient was asleep at a time when the last dose of medications were due, then coordinating with nursing to provide pain medications ahead of the PT session would be appropriate. 2. Lower limb strength can be assessed with the patient in supine or sitting at the edge of the bed. 3. Either a step transfer to the commode or preferably ambulation to the rest room would be appropriate goals for
CASE STUDIES The following are two case studies that require the application of content learned during this learning module. Case study one
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Book Code: PTNY3622B
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