Assessment and Interventions for Return to Work after a Lower Extremity Injury/Surgery

Assessment and Interventions for Return to Work after a Lower Extremity Injury/Surgery

Andrew Kohler, SPT
UNC PT Outreach – 2016

Overview:
At the end of April, I will be traveling to Antigua, Guatemala with a team of physical therapy students and faculty from UNC for the annual UNC PT Outreach Service Learning trip. The UNC PT Outreach service project began traveling to Guatemala in 2010 to provide education and clinical care to underserved populations while increasing cultural competence among physical therapy students. (1) This year’s trip will consist of working alongside Guatemalan therapists at the hospital Las Obras Sociales del Santo Hermano Pedro (Las Obras) and at a community school for children with disabilities called Enseñame a Pescar. We will also be hosting multiple health fairs at several locations in the surrounding communities of Antigua.

I encourage everyone to follow our experience on our UNC PT Outreach blog at: http://uncptoutreach2.blogspot.com/

My Capstone was developed to serve as an educational lecture to the Guatemalan therapists and therapy students. I discussed patient characteristics and PT educational needs with faculty and students who served on previous trips. Based on the most appropriate needs for the therapists and my personal interests, I decided to investigate the assessment and interventions for return to work after a lower extremity injury/surgery with an emphasis on implementing closed chain exercises. I designed my Capstone to address the following purposes: 1) to provide education to the Guatemalan therapists at Las Obras of the components for an appropriate individualized return to work/sport assessment, and 2) to describe a safe progression of closed chain exercises that address patient limitations in locomotion, strength, and balance.

Throughout the year the therapists at Las Obras are exposed to orthopedic surgeries and are responsible for providing interventions and home exercise plans for the patients. Historically, the therapists prescribe countless open chain therapeutic exercises and do not properly re-evaluate the patient to determine if the patient is ready to return to higher-level activities such farming or construction work. The Guatemalan therapists could benefit from a presentation on more advanced closed chain lower extremity exercises and appropriate return to work evaluations in order to improve the quality of care provided to the patients.

Final Products:

One of the main objectives of this project was to effectively deliver a useful presentation. A major obstacle in the preparation of this project was to create it in a way that is culturally sensitive and appropriate for the target audience. I used the resources found on the DPT Capstone site to help guide my presentation development. (2,3) In addition, I completed a Health Literacy Assessment to ensure that all of my materials were tailored appropriately. Based on these resources and feedback from my adviser, Lisa Johnston, I edited my materials to account for a lower health literacy.

I reviewed the current literature on the benefits of incorporating closed chain exercises during the rehabilitation of a lower extremity injury/surgery. I completed a brief Evidence Table to outline several of the results. Please note that this evidence table does not provide all of the evidence that supports closed chain exercises for rehabilitation needs, as an in depth examination of all of the literature was not within the scope of this project.

I constructed a PowerPoint Presentation titled “Assessment and Interventions for Return to Work after a Lower Extremity Injury/Surgery” (English/Spanish). I translated all of my materials and the verbal script myself. After my translation, I met with my Spanish for Health Professionals professor to proof read and assist me in making the necessary corrections. I will presenting in Spanish and will provide an English version of my presentation to the English speaking audience members. I am extremely excited to present in Spanish and have been preparing myself to deliver this presentation to the best of my ability. After the presentation, I will lead a hands-on lab activity to further apply any and all new concepts to the audience. In addition to my presentation, I have developed a patient friendly handout to serve as a Home Exercise Plan. This home exercise plan provides the patient with several closed chain strength and balance exercises and how one can progress the exercises. My intentions are for the therapists to utilize and refer to these materials for future clinical practice.

Professional Interest:

This topic correlates well with my professional development and career goals. I have a passion for the Hispanic culture and have professional goals to work within a Hispanic community and/or be involved with international PT medical missions similar to this service trip with UNC. A primary goal of this project was to present in Spanish. I studied Spanish as an undergraduate and continued to take Spanish elective courses during my DPT studies. This Capstone presentation will provide me with practical experience in delivering international health care and enhance my health professional Spanish language skills. Presenting on an orthopedic topic will deepen my education in my quest in becoming an orthopedic therapist.

Personal learning objectives for presenting in Guatemala:
• Deliver my Capstone presentation in Spanish to improve my health professional Spanish language skills.
• Improve my understanding of the rehabilitation needs in Guatemala through research and communication with staff and colleagues.
• Effectively educate the Guatemalan therapists with evidence-based practice to improve the quality of care for future intervention strategies.
• Expand my connections to international PT opportunities by effectively networking with service leaders and local therapists in Guatemala.

Evaluation:

At the end of my presentation I will ask everyone in attendance to fill out a presentation evaluation form. (Evaluation Form) This will provide me with feedback on my performance and give the audience an opportunity to make suggestions for improvement. The form addresses the presentation’s organization, quality of content, relevance to clinical practice, the usefulness of the lab activity and handout materials.

Acknowledgements:
I would like to say a special thank you to Lisa Johnston, my Capstone Adviser, for her support, invaluable feedback, patience, and guidance in the development of this project. Additionally, I’d like to thank my committee members, Sarah van der Horst and Antonio Balsón, for their support and assistance in translating my materials. Finally, I’d like to send my sincerest gratitude to my friends and family members who have supported and encouraged me through this whole process.

References:
1. Department of Allied Health Sciences: Physical Therapy. UNC PT Outreach 2012. Available at: http://www.med.unc.edu/ahs/physical/news/unc-pt-outreach-2012. Accessed April 21, 2016
2. Jensen GM, Monstrom E. Handbook of Teaching and Learning Physical Therapy. Third Edition. Chapter 12: Patient Education and Health Literacy.
3. Plack M, Driscoll M. Teaching and Learning in Physical Therapy From Classroom to Clinic. Chapter 4: Systematic Effective Instruction: Keys to Designing Effective Presentations.