【論文摘要】Pain Education and Graded Exposure for Complex Knee Fracture-A Rare Case

【論文摘要】運用疼痛教育以及漸進式暴露於複雜膝關節骨折－個案報告

陳柏禎(Bo-Jhen Chen)

《物理治療》 46卷2期 (2021/06) Pp. 162-162

https://doi.org/10.6215/FJPT.202106.P58

摘要

Background and Purpose: Prognosis after complex fracture largely depends on severity of the initial trauma and following surgical reconstruction. Early mobilization after surgery is essential for recovery and better function. However, persistent pain after tissue has healed often hinders patients' will to move because of fear-avoidance. We herein apply cognitive-behavioral approach to reassure a case with complex musculoskeletal injury. Methods: This was an aged 36 male (height: 180 cm, weight: 65 kg) without previous trauma. He served as a process engineer needed standing for six hours a day. He suffered from pedestrian injury that hit by a car, resulting in right distal femoral Hoffa fracture, Schatzker VI proximal tibia fracture, patella dislocation, and avulsion fracture of the anterior cruciate ligament. Surgical reduction with locking plates and allograft were performed and good joint congruity was achieved. He started physical therapy immediately after operation. Because of limited gain in range of motion (ROM) one year after the accident, he received removal of the implant with surgical release of fibrotic and scar tissues, following by manipulation. However, parasthesia and tightness during activities was still presented after aforementioned procedure. Aside from previous manual therapy and modality therapy, pain education with graded exposure to various daily tasks and movements were administered. Goals of intervention shifted from symptom modification to enhancement of self-efficacy. Results: Post-operatively, the range of motion was 10-28° at first visit, and pain was 8 on a 0-10 scale. Immediately after the manipulation under anesthesia, the ROM increased from 0-90° to only 0-95°, as the pain maintained 4-5/10. The physiatrist discharged him after accessing to graded exposure for 11 sessions. Upon discharge, he had 0-105° ROM with 3 on pain scale. Despite limited physiological movement and remaining minor pain, he could go jogging, playing sport games with his children without discomfort or difficulty except squatting. No more job absenteeism and worker compensation was required. Conclusion: Although the patient was unsatisfied with the improvement of ROM, he regained majority of functional expectations. The positive results encourage application of pain education and graded exposure to movement in chronic pain management. Clinical Relevance: Traditional point of view has attributed the cause of painful disability to sole biomechanical factor. Evidences have recognized the influence of personal belief on pain perception. Behavioral support is promising in improving pain-related fear and unhelpful cognition.