Case Study Analysis
Course Code: TecMSc
Course Name: PTA Therapeutic Techniques 1: Musculoskeletal
Version: XXXXXXXXXXMarch, 2015
Assignment: Fi
omyalgia: Case Study Analysis
Materials and Resources
Textbooks
Dreeben-Irimia XXXXXXXXXXPhysical Therapy Clinical Handbook for PTAs.
Gainesville, Florida: Jones & Bartlett Learning.
NPAG XXXXXXXXXXEssential Competency Profile for Physiotherapist Assistants in
Canada.
Student Workbooks
Introduction to Rehabilitation (IntRh)
Software
Physiotec on-line exercise prescription software @ www.physiotec.ca
Websites
http:
www.physio-pedia.com/Category:Outcome_Measures
http:
www.rehabmeasures.org/Lists/RehabMeasures/DispForm.aspx?ID=895
www.collegept.org
http:
fiqrinfo.ipage.com/index.html
https:
owl.english.purdue.edu/owl
esource/560/01
Assignment Description
This assignment will help students integrate knowledge and skills developed in this course as well as previous courses. Specifically, analysis of the case study will help prepare students to perform the following: demonstrate an understanding of client-centered practice, support an evidence-informed approach, implement assigned interventions, collaborate with other team members, use effective written communication skills, prepare written materials to support service delivery, contribute to the creation of an effective practice environment, and assist clients in making life changes in support of their health goals.
Assignment steps
1. This assignment must be completed individually.
2. Read the case study carefully.
3. Answer the questions using the resources listed above.
4. Your answers should be typed, with each question clearly labeled. You may answer in point form, as long as your provide your instructor with enough detail to follow your train of thought, and use co
ect spelling and punctuation.
5. Include a reference list. This should be formatted according to APA guidelines. Refer to https:
owl.english.purdue.edu/owl
esource/560/01
2
CASE STUDY: FIBROMYALGIA
You are the PTA/OTA for the Joint Wellness Program, an interdisciplinary therapy and education program that assesses, treats and educates clients with a variety of arthritic conditions including inflammatory arthritis, osteoporosis, osteoarthritis and fi
omyalgia. The program is affiliated with the community’s regional hospital but is physically located in a commercial mall with a variety of businesses, offices, retail stores and recreation facilities, including a YMCA and a movie theatre. Team members include two rheumatologists, a pharmacist, a dietician, a social worker, an occupational therapist, a physiotherapist, clerical staff and several volunteers. Most of the volunteers are graduates of the Joint Wellness Program.
The Joint Wellness Program is based on a chronic disease self-management model, a community-based approach that has been gaining in popularity worldwide. This approach emphasizes the client’s role in managing chronic illness. The self-management model is designed to provide clients with the knowledge, skills and confidence they needs to actively deal with their own illness-related problems and avoid dependence on healthcare professionals (Brady et al., 2013; Lorig et al., 2001).
Although each client is assessed individually, and some individual counselling and treatments are offered, many of the interventions in the Joint Wellness Program are provided in a group format. For example, the social worker and volunteers lead support groups. As the PTA/OTA on the team, you lead exercise classes with groups of six to eight clients. In addition, the team delivers regular 30 minute group education session on topic such as:
· The pathophysiology of specific conditions such as fi
omyalgia
· Nutrition for general health
· Medications for pain management and other symptoms
· Non-pharmacological pain management (modalities such as heat, cold and electrical stimulation)
· Energy conservation techniques
· Sleep hygiene
· Joint protection techniques and assistive devices
· Exercise
· Stress management
You are working with a new client, Anita Hope, a 43 year-old woman with fi
omyalgia. Anita spent more than ten years visiting doctor after doctor, desperately seeking a diagnosis for her chronic fatigue, generalized pain, and sleep distu
ances. She also has i
itable bowel syndrome, but did not realize this could be related to her other symptoms until she was finally diagnosed with fi
omyalgia.
Her symptoms increased after the birth of her second daughter eight years ago, so her family doctor initially diagnosed her with post-partum depression and prescribed anti-depressants. The medication helped slightly, but failed to address most of her symptoms. Finally, she was refe
ed to a rheumatologist in the Joint Wellness program, who diagnosed her with fi
omyalgia. Although Anita is relieved to finally have a diagnosis that
makes sense to her, she has spent so many years being disappointed by her health care providers that she is skeptical about the fi
omyalgia therapy and education program.
She is cu
ently taking amitriptyline, an antidepressant, and pregablin a medication used to treat fi
omyalgia pain. Anita also takes over-the counter pain killers and anti-inflammatories. The pharmacist has concerns about the amount of over-the-counter medications Anita is taking and their possible interactions with her prescribed medications.
She will be attending two 90 minute group sessions for clients with fi
omyalgia per week for the next six weeks. This will include 60 minutes of education and 30 minutes of exercise. Additional individual sessions with appropriate team members will be scheduled as needed.
Anita lives with her husband and two daughters in a small townhouse. Anita’s husband works as a financial advisor, and Anita works part-time as a translator, a job that allows her to work from home. Together they make a reasonable income, but since Anita started working part-time eight years ago, they do not have a lot of money for extras, such as vacations a
oad or music lessons for the kids.
Over the years, Anita’s level of activity has progressively decreased. She rarely leaves the house and spends up to six hours a day resting. She is afraid of doing anything that may provoke pain, so she avoids physical activity and retreats from other daily tasks. For example, most of the housekeeping activities have been taken over by her husband and her eldest daughter. Lately, her relationship with Theresa, her sixteen-year-old daughter, has been strained. Theresa resents doing so many household chores and accuses her mom of being lazy. In contrast, her husband reinforces Anita’s pain-avoidance behavior by
inging Anita pain medication and telling her to rest, even if Anita has not expressed a need to do so.
In keeping with an interdisciplinary approach, the OT and the PT assess all clients together (Jessup, XXXXXXXXXXAs the PTA/OTA you also attend the assessment when it fits into your schedule. Depending on the client’s goals and primary treatment interventions, often either the PT or the OT takes the lead as rehab therapist with a specific client. The OT and PT are cross-trained so they can provide treatments that may traditionally fall under another discipline. For example, as many of Anita’s goals and interests are related to exercise, the PT will be taking the lead in her rehabilitation, including education in areas such as energy conservation. The OT will work with Anita on increasing her involvement in household chores.
Significant findings from the assessment:
Impairments:
a) Pain: Average pain rated at an average of 8/10 in the last 24 hours in the areas located in the pain diagram below:
Score of 60/78 on the McGill Pain Questionnaire, with affective-evaluative descriptors chosen including “wretched” and “miserable” and “fearful”. Anita identified that stress, physical activity and poor sleep increase her pain.
) Body composition: Weight: 83 kg, Height: 172 cm BMI: 28; waist girth: 90 cm;
XXXXXXXXXXbody fat percentage: 35% (as measured using skinfold calipers)
c) Strength: 4/5 in all shoulder, elbow, hip and knee movements. Client reported an increase in pain
XXXXXXXXXXfrom 7/10 to 9/10 with testing. Hand grip as measured with the dynamometer 19kg on the
XXXXXXXXXXright and 18 kg on the left
d) Standing Posture: Moderate head protraction, increased g/h internal rotation, mild bilateral foot overpronation and increased shoulder protraction noted.
Activity Limitations:
a) Functional ambulation and endurance as measured by the six-minute walk test: 441 m, with one 20 second rest require due to pain and fatigue. Client c/o increased neck, back and LE pain from 7/10 pre-test to 8/10 post-test. HR at rest: 80bpm,strong and regular; HR immediately post-test 95 bpm, strong and regular.
Participation Restrictions:
a) Score on the Revised Fi
omyalgia Impact Questionnaire (FIQR): 60/100
) Anita would like to work full-time, but at present she cannot work more than twenty hours per week.
c) Anita has given up all active leisure activities. In the past she enjoyed hiking and swimming.
Environmental Ba
iers:
An ergonomic assessment of Anita’s workstation at home revealed a chair with poor lumbar support, and the computer screen and keyboard elevated too high.
Goals:
Anita and the physiotherapist have developed the following goals:
Impairments:
a) Pain:
LTG: Anita’s average pain rating will decrease to an average of 4/10 over a 24 hour period in six months. She will no longer identify her pain as “wretched”, “miserable” or “fearful”.
STG: Anita’s average pain rating with decrease to an average of 5/10 over a 24 hour period in six weeks.
Anita will achieve these goals by using therapeutic modalities such as heat as needed, exercising 3-5 times per week, and practicing daily relaxation exercises.
) Body Composition:
LTG: In one year, Anita will lose 10 kg, lower her BMI to 25, decrease her waist girth to 80 cm, and decrease her body fat percentage to 30%
STG: In six weeks, Anita will lose 2 kg in six weeks, lower her BMI to 27.4, and decrease her waist girth to 88 cm, and decrease her body fat percentage to 34%.
Anita will achieve these goals by working with the dietician to prepare healthier meals, and participating in an exercise program 3-5 times per week.
c) Strength:
LTG: In six months, Anita’s strength will increase to 5/5 in all joints as tested with MMT.
STG: In six weeks, Anita will be able to tolerate MMT with an increase of pain of no more than 1/10; strength will be stable at 4/5.
Anita will achieve these goals by completing gentle strength training exercises as prescribed by the PT 2-3 times per week