Physiotherapy Management of Comobidity of Post Knee Arthroscopy and Mental Disorder: Case Study

Abstract

Mrs M.A was referred to physiotherapy for the rehabilitation of function post Right (R) Knee Arthroscopy. The referring surgeon described her over the phone as a difficult patient and that her case was of great concern to the company she works for. A 39 years old professional with frayed lateral and medial meniscus; lateral meniscial tears with medial femoral condral defect. She was also referred to a psychiatrist 10 days before surgery who managed her for 3 days as Spectral Analysis (Neurofeedback and Central nervous system vital signs assessment) was indicative of anxiety and/or depression. She regretted going in for surgery and lacked confidence in her work environment. Outcomes: By the 18th therapy session of Physiotherapy at the end of week 6, Pain reduced from Score 10 to Score (4) VAS, Muscles' strength increased from Grade 2/2+ to 4/4+ Oxford muscle grading, Range of motion increased from 00 -1000 to 00 -1200 which is the normal; Function improved from non weight bearing crutch walking wearing 0.5 inch sandal to normal gait wearing inch foot wears. Built confidence and settled at work with team members such that she could work outstation; Life events scale score reduced from 549 to 289. However at week 10 she reported back with exacerbation of pain, score (10) as a result of handling a household emergency. Conclusion: The occurrence together of musculoskeletal conditions and mental disorders in the same person often complicates treatment and management plans. Clinical management of people with comorbid conditions can be more complex and time consuming than for those with single conditions. Mental health status of patients should be assessed prior to surgery, and physiotherapists irrespective of specialty areas of practice should take cognisance of the fact that anyone referred for rehabilitation should be managed with holistic and biopsychosocial approaches in the context of the WHO International Classification of Functioning, Disability and Health.