The performance of TE typically began with a range of motion exercises as a warm-up activity. Strengthening, self-stretching, and balance exercises then followed. The patient was also provided with appropriate rest periods (30-60 s) in between exercises. The duration of the rest phase depended on the patient’s willingness to proceed to the next activity. Heart rate and blood pressure measured the exercise intensity. The patient also utilized deep breathing exercises to help her relax throughout the session. Lastly, the stationary bicycle served as the cool-down period at the end of the therapy session.
Manual therapy was a “hands-on” treatment given to the patient. The patient was instructed to relax as much as she could and to report any pain aggravation during the session. 30-60 s rest with deep breaths was also given to the patient to allow her to calm down after each repetition.
The patient attended a total of eight therapy sessions. Her compliance with home program was good with 100% competency. Her exercise log indicated that she was able to perform all her HEP at prescribed schedule. There were no significant issues that prompted the discontinuation of treatments throughout the case period.
Outcomes
The patient showed improvement in all outcome measures at the end of Week 2. Her WOMAC Score decreased from 44/96 to 35/96, higher scores indicate severe pain, stiffness, and functional limitations. Her score was still in the middle range, but more items were graded in the mild category compared to baseline. The patient also walked farther as shown in her 6MWT from 350 m to 380 m. Although her score still indicated that she had decreased endurance at the end of Week 2. Pain intensity during weight-bearing activities, in the morning, and during palpation of the leg decreased compared to baseline. The patient also felt no pain at rest in Week 2. AROM and PROM for bilateral LE muscles also increased except for both ankle dorsiflexion and plantar flexors which were already within normal limits even at IE. The strength of all LE muscle tested also improved by at least a grade. The swelling was resolving as demonstrated by a reduction in limb girth. BBS score also increased from 50/56 to 52/56 decreasing her risk for falls. BMI at Week 2 was not assessed because the weighing scale was unable for use at that time.
Further improvement in the patient’s outcome measures was observed at the end of Week 4. WOMAC Score further improved to 21/56 and the majority of items were graded mild. This could indicate that patient has milder symptoms at the end of the case period. 6MWT was at 420 m compared to 380 m at Week 2, though this result still indicated decreased endurance. Pain intensity during weight-bearing activities, in the morning, and upon palpation was further reduced to mild pain with the highest pain reported at NPRS= 2/10. AROM/PROM and MMT increased more at the end of the case period. Swelling in both knees was further reduced as shown by decreased limb girth at Week 4. The risk of falls was also reduced as BBS score increased especially on items testing balance on a narrow base of support. The patient lost weight as exhibited by decreased BMI, though the patient was still in the overweight category. The patient could then ambulate for longer distances (~600 m). Pain persisted once she stopped, but it was tolerable (NPRS= 2/10), so AD was unnecessary. The patient also demonstrated an alternating step pattern during stair negotiation with decreased use of the hand for support. Outcomes are summarized.
