Case Study
You Never Know What a Person in a Chair Can Do by Suzanne Rodriguez, PT Editor’s Note: This clinical case commentary was part of content for the November 2020 Journal Club. These case studies are intended to demystify the more formal statistics and format of a peer-reviewed article and translate key concepts into clinically usable information. Join us for Journal Club on the third Tuesdays of January, March, May, July, September and November at 8 pm ET to discuss current concepts with a wide range of peers.
Subjective examination Primary complaint: Mrs. Nackid is a 91-year-old female referred to home-based outpatient physical therapy for management of bilateral knee pain as a result of bilateral knee osteoarthritis. She reports a significant worsening of knee pain following a fall one year ago that resulted in a right hip fracture corrected with surgical ORIF. She attributes a quick progression of the arthritis in her knees to a period of decreased mobility immediately following the injury. Mrs. Nackid states that her knees are very stiff in the morning and she has a difficult time rising from a seated position throughout her daily routine. She also reports that she now finds herself knock-kneed, bent over and states that she is very fearful of falling again. Medical history and current medications: Hypertension, bilateral knee osteoarthritis, right hip fracture s/p ORIF (October 31, 2019), lung cancer, and incontinence. Her vision is corrected with glasses, post cataract surgery for correction. She has age-related hearing loss for which she wears hearing aids. Her fall history is significant GeriNotes • November 2020 • Vol. 27 No. 5
for two falls in the past year. Daily medications include: Metoprolol ER 25 mg 1x/day, Simvastatin 20 mg 1x/day, Hydrochlorothiazide 12.5 mg 1x/day, and Meloxicam 7.5 mg 1-2x/day prn. Home environment and current level of function: Mrs. Nackid is widowed and lives alone in a multi-story home. Her bedroom is on the second level; there is a full tub/ shower combination bathroom on the second level and a half bathroom on the first level. There are four stairs to enter the home, two without access to rail. She is unable to climb a flight of stairs to access her bedroom and full bathroom upstairs since the hip fracture and is not interested in installing a stair lift. Mrs. Nackid sleeps in a twin bed in the TV room on the first level but misses her bedroom immensely. She was widowed early, at age 40, is childless, and has lived alone in her home since that time. She worked as a secretary until her retirement at 65 years of age. Social support is provided by neighbors, a good friend and a nephew from her husband’s side of the family who come in and check on her, assist with 31
