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In-patient rehabilitation following a right total knee arthroplasty
A 55-year-old patient with a total knee arthroplasty was seen six days a week for three weeks at a skilled nursing facility. Treatment was provided by a student physical therapist under the supervision of a licensed physical therapist. The patient was evaluated at the initial encounter with goniometry, the Numeric Pain Rating Scale, the Western Ontario and McMaster Universities Arthritis Index (WOMAC), 10 Meter Walk Test, the Tinetti Performance Oriented Mobility Assessment, and the assessment of independence level in the performance of functional activities; and a plan of care was established. Problems found were decreased range of motion of the knee, increased pain, decreased strength, decreased balance, decreased gait speed, and decreased independence with functional activities. The main goals of the treatment course were to decrease pain, increase range of motion of the knee, increase balance, increase gait speed, and achieve independence with functional abilities. The main interventions used were range of motion activities, strength activities, and task-specific functional activities. The patient met her goals in pain level, balance, gait speed, and ability to climb stairs. The patient made some progress but did not meet her goals in knee range of motion, functional activities as measured by the WOMAC, and the ability to participate in community outings. She was discharged home with an exercise program and was to continue physical therapy in an outpatient setting.