Abstract: Background/Purpose: Osteoarthritis (OA) affects a large population of adults and can lead to disability. Many times the preferred method of treatment is total knee arthroplasty (TKA). Also, the use of continuous passive motion (CPM) as an adjunct to physical therapy (PT) status-post (s/p) TKA is common. However the effectiveness of CPM treatment (tx) has recently been questioned. The purpose of this case report and evidenced based analysis was to present the findings of the literature review on the effectiveness of CPM as an adjunct to PT and discuss interventions that were performed with an 82-year-old female, patient A, who had a primary diagnosis of L knee OA and underwent a L TKA. Case Description: An 82-year-old female with a primary diagnosis of L knee OA, s/p L TKA, with multiple comorbidities, including diabetes mellitus type II, hypertension, and hyperlipidemia. Patient A came to Lovelace Medical Center-Downtown to undergo a L TKA. Her PT diagnosis is Impaired Joint Mobility, Motor Function, Muscle Performance, and Range of Motion Associated with Joint Arthroplasty (Pattern 4H). She was seen by physical therapy (PT) on post-operative day 0 (POD 0) to initiate her PT protocol and facilitate her recovery. She received a CPM machine on POD 0, which was set from 0-45 degrees of knee flexion and was used 2 hours per day, with knee flexion ROM being increased by 5 degrees, every new CPM session. She also underwent traditional PT treatment consisting of early (POD 0) mobilization, ROM, and strengthening. Prognosis and Outcomes: TKA pts generally have good functional and ROM recovery. Typically, at Lovelace Medical Center, they are seen for PT treatment twice a day for 30 minute sessions, until discharge (d/c), which usually occurs on POD 2 or 3, depending on pts comorbidities and functional status. Patients are usually discharged ambulating with an assistive device, generally a front-wheeled walker (FWW), and they undergo continued physical therapy, either in an inpatient rehab facility, outpatient clinic, or at home, until they have achieved their PT goals, which usually consist of ambulating without an assistive device, achieving adequate ROM for functional tasks, or reaching prior level of function. Patient A was discharged to a skilled nursing facility (SNF) with a FWW, due to inability to perform ADLs, transfers, and ambulation in a sufficient manner to return home with her elderly sister. Discussion: The use of CPM is controversial, and there is conflicting evidence as to the efficacy of this treatment and whether it improves outcomes as opposed to traditional PT treatment alone. Therefore, a literature review was performed to examine the current evidence about CPM treatment and whether or not it is an effective and worthwhile adjunct to traditional PT treatment in any of the settings it is typically used.
Submitted by Leann Nichole Bullock (lbullock) on 2015-06-23T14:56:00Z No. of bitstreams: 2 capstone final paper.docx: 210031 bytes, checksum: 50b5d16df92fa9e2c293051700c14fd1 (MD5) final poster.pdf: 734799 bytes, checksum: 2ce02cbeef43a0d82c639eac616f8681 (MD5), Made available in DSpace on 2015-06-23T14:56:00Z (GMT). No. of bitstreams: 2 capstone final paper.docx: 210031 bytes, checksum: 50b5d16df92fa9e2c293051700c14fd1 (MD5) final poster.pdf: 734799 bytes, checksum: 2ce02cbeef43a0d82c639eac616f8681 (MD5) Previous issue date: 2015
Physical Therapy, TKA, CPM, functional outcomes, PT
Bullock, Leann. "Physical Therapy Treatment of TKA: A comparison of CPM as an adjunct to PT intervention vs solely PT intervention." (2015). http://digitalrepository.unm.edu/dpt/119