Management of a patient following total knee arthroplasty in the subacute rehabilitation setting: a case study

A patient, status post right total knee arthroplasty, was seen for physical therapy treatment 2 times each day, 6 days each week, over the course of 23 days, in 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, manual muscle testing, Wells criteria, the numeric pain rating scale, the Timed Up and Go test, the 6- minute walk test, California Department of Health Care Services assistance levels, Stanbridge Colleges’s Graded Posture Movement Ability of Individual, and patient report. A plan of care was then established. Main goals for the patient were to improve level of independence, and return home to continue a morning walking program with her sister. Additional goals included improving lower extremity range of motion, strength, static and dynamic standing balance, functional and bed mobility, walking endurance, transfer and ambulation ability, and decreasing pain. Main interventions used were goal-oriented, functional, and impairment-based, with use of progressive overload, and included strengthening and range of motion exercises, and gait and functional training. The patient improved range of motion, strength, balance, walking endurance, functional mobility, and independence with activities of daily living. The patient was discharged home with a home exercise program, and scheduled to receive home-health physical therapy.