Comper Care Outpatient Physical Therapy with Michael Black DPT

MIKE'S FORMS ON WEIGHT BEARING AND PROTOCOL CLARIFICATION, ORTHOPEDIC DIFFERENTIAL DIAGNOSIS

HOW DOES PT COMMUNICATE WITH ORTHO?

What I taught the Keystone staff is that every orthopedic follow-up should be scheduled by physical therapy and a SOAP note progress report with orders (see below) should be sent. These are returned to the rehabilitation facility, and scanned into the medical record for therapy and assistant consistency.

EXAMPLE 1: WHAT DOES A PHYSICAL THERAPY PROGRESS REPORT LOOK LIKE AFTER YOU REQUESTED MOBILE X-RAY AND A FRACTURE IS DETECTED?

Diagnosis: Bilateral femoral lateral epicondylar fractures, peri-prosthetic around R TKA DOS 13 years L TKA 15 years ago respectively.

Subjective: Patient reports chronic knee pain for the last year, VAS 6/10 at rest, 8-9/10 with standing, Reports onset after colliding with the bathroom doorway on the R lateral knee and refrigerator on the L lateral knee while propelling the power wheelchair. Patient reports receiving home health physical therapy prior to this outpatient ALF PT referral, for knee stretching, isometric quadricep strength training, and attempts at gait training with pain education. States, prior to one year ago, walking in the bathroom using UE support to cruise along the sink, and transfers using stand-pivot with front wheeled walker.

Objective: Patient is currently non-ambulatory and slide board dependent for transfers; demonstrates PMHx osteoporosis with annual DEXA scans and injection therapies in addition to chronic corticosteroid treatment with history R femoral neck fracture and pathologic fracture precautions noted. This physical therapist did recommend a mobile x-ray secondary to age of B TKA and knee pain of traumatic onset. The impression arrived this a.m. with diagnosis of B femoral fracture, peri-prosthetic above TKA hardware.

Assessment/Plan: Orders are included for your convenience. Please check boxes and complete prescription as indicated. Defer to your expertise!

___ Weight bearing status (please circle) R TKA:     NWB     TTWB     PWB     WBAT     Other (WBAT for transfers only)

___ Weight bearing status (please circle) L TKA:     NWB     TTWB     PWB     WBAT     Other (WBAT for transfers only)

AND

___ Physical therapy to discontinue R knee ROM, strength training

___ Physical therapy to discontinue L knee ROM, strength training

___ Other orders/instructions: 

___ Next follow up appointment: 

Thank you for your trust with this patient! Michael Black PT, DPT

Physician signature ____________________ Date: __________

EXAMPLE 2: WHAT DOES YOUR PHYSICAL THERAPY PROGRESS REPORT LOOK LIKE WHEN YOUR ORTHOPEDIC MUSCULOSKELETAL DIFFERENTIAL DIAGNOSIS IS DIFFERENT THAN THE REFERRAL DIAGNOSIS?

Referral diagnosis: Sciatica with low back pain evaluate and treat for lumbar radiculopathy.

Subjective: This patient was referred with dx: sciatica and PMHx lumbar intervertebral foramen nerve block injection therapies without success reported. Patient reports R radiating groin pain that occurs during R LE stance phase of gait and no c/o radiating pain with lumbar active range of motion or posture.

Objective: Patient demonstrates (+) coxofemoral quadrant sign with reproduction of radicular pain “that’s the exact same in the groin”. Patient demonstrates (-) lumbar nerve root compression testing including (-) slump, (-) cough/sneeze, (-) vertical spinal compression, and no symptom reproduction with all lumbar cardinal plane movement.

Assessment/Plan: Patient demonstrates s/s remarkable for hip osteoarthritis or other pathology i.e. femoral head fracture or avascular necrosis. Orders are included for your convenience. Please check boxes and complete prescription as indicated. Defer to your expertise!

_____ Hold physical therapy pending R hip xray imaging to rule out femoral head pathology

_____ Continue physical therapy and monitor symptoms with additional instructions as follows:

_____ Next follow up appointment: 

Thank you for your trust with this patient! Michael Black PT, DPT

Physician signature ____________________ Date: __________

EXAMPLE 3: WHAT DOES THE PROGRESS REPORT LOOK LIKE FOR A SCHEDULED ORTHOPEDIC FOLLOW-UP WITH THE NEED FOR CLARIFICATION ORDERS FOR WEIGHT BEARING AND BRACING PROGRESSION

Diagnosis: R metatarsal fracture with forefoot NWB, hindfoot WBAT, L LE NWB s/p patellar fracture

Subjective: Patient denies pain with R forefoot and hindfoot pain. Denies L patellar pain also.  

Objective: Patient demonstrates compliance with the current weight bearing orders. Progression orders included for your convenience.

Assessment/Plan: Orders are included for your convenience. Please check boxes and complete prescription as indicated. Defer to your expertise!

___ Progress R forefoot WBAT or other: _____________

___ (Please circle) Progress R hindfoot   /   forefoot therapeutic exercise as follows: AROM   /    AAROM   /   PROM   /   Stretching   /   Mobilization and manual therapies

AND

___ Continue L LE NWB

___ Continue L knee immobilized into terminal extension

OR

___ Progress L LE NWB (Please circle): TTWB   /   PWB   /   WBAT   OR   OTHER INSTRUCTIONS: 

___ Unlock L knee brace as follows: ____ degrees every _____ weeks for the next _____ weeks

___ Next follow up appointment: 

Thank you for your trust with this patient! Michael Black PT, DPT

Physician signature ____________________ Date: __________


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