Regis Dpt Class Of 2009 Foot/ankle Aop Project

Practice Patterns and Outcomes of Care for Patients with Common Foot and Ankle Disorders Anna G. Chartrand, Jennifer L. Gunlikson, Katie C. Hopkins, Jamie R. King, Katie E. Reinhart, Larissa C. Rodrigues, J. Timothy Noteboom, PT, PhD School of Physical Therapy, Regis University, Denver, CO

We examined the diagnoses student physical therapists identified in the clinic and determined which interventions were implemented. We wanted to identify if these interventions correlated to the most current evidence. Purpose: The purpose of this analysis of practice was to identify the most frequently encountered foot and ankle disorders as well as to determine the most commonly used physical therapy interventions for these disorders.

METHODS • Data collected by student physical therapists on 4 clinical affiliations at multi-center clinics on pts with 8 different foot and ankle diagnoses. • Data collection included: • Initial and final Foot and Ankle Ability Measure • Activities of Daily Living score (FAAM ADL)2 • Ankle dorsiflexion range of motion (ROM) • Numeric Pain Rating Scale (NPRS) • 1st metatarsal phalangeal joint (MTP) extension ROM • Patients classified as successful if they exceeded the Minimal Clinically Important Difference (MCID) for both primary outcome measures: • NPRS > 2 point decrease • FAAM ADL > 10 point increase • Data was coded and statistically analyzed with SPSS 17.0 version primarily consisting of descriptive and correlational statistics • Statistical significance set at p<.05

DISCUSSION:

Mean Change in NPRS by Diagnosis

• Total Subjects: 89 (Female= 51; Male=38)

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• Average age: 41.9 years

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• Average Number of Visits: 8.8 visits

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• Average Duration of Symptoms: 72.9 days • Sixteen percent of patients presented with comorbidities, 84% did not.

NPRS

The rehabilitation process for foot and ankle disorders is challenging. Controversy exists regarding effectiveness of therapeutic approaches for various lower leg, foot and ankle disorders. There is limited research regarding optimal outcome measures and evidence based interventions used to manage ankle/foot disorders1.

RESULTS

The majority of patients in this clinical study experienced a significant improvement in function and reduction in pain following a course of physical therapy care. The mean NPRS and FAAM-ADL scores were significantly different at end of care compared to baseline, with a mean change of 3.2 for NPRS and 16.4 for FAAM-ADL. Using the MCID values to dichotomize patients into Success vs Nonsuccess group indicated that 56% of patients had a successful outcome.

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MCID = 2

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• Most Common Diagnoses: 1

• Plantar Fasciitis (n=41)

The outcomes in this study are comparable to those by Whitman et al3 who reported a 75% success rate for acute ankle sprain patients receiving thrust and non-thrust mobilizations and exercise, and who had mean NPRS (2.0) and FAAM-ADL (18.1) change scores following two PT sessions.

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• Inversion Ankle Sprain (n=13)

Plantar Fasc.

Ankle Sprain

Post-op

Overall

• Post Surgical (n=20) Mean Change in FAAM-ADL by Diagnosis

• 46 patients were classified as Success and 35 patients as Non-success

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• There was no effect of sex or presence of comorbidity on Success vs. Non-success groups • The mean number of visits differed by diagnosis but not by Success vs Non-success group

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FAAM-ADL

INTRODUCTION

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CLINICAL RELEVANCE

20

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Outcome Measures

Mean Change from Baseline to End of Care

10

0

Dorsiflexion PROM

6.3 degrees

1st MTP Extension PROM

8.5 degrees

NPRS at Worst

3.2 points

FAAM ADL

15.3 percent

Diagnosis

#1 Intervention

#2 Intervention

#3 Intervention

Plantar Fasciitis/osis

Patient Education

Muscle Stretching

Soft-Tissue Mobilization

Ankle Sprain

Patient Education

Joint Mobilization

Strengthening Exercises

Post Surgical

Patient Education

Muscle Stretching

Strengthening Exercises

MCID = 10

Plantar Fasc. Ankle Sprain

Post-op

•

Overall

Diagnosis

# of Visits

Success

Non-success

Plantar Fasciitis/osis

6.7 + 3.7

68%

32%

Ankle Sprain

8.0 + 5.0

92%

8%

Post Surgical

16.6 + 22.8

40%

60%

• The FAAM and NPRS scores were moderately inversely correlated (r = -.59). There was low correlation with ROM measures ( r = .05 - .32) • Mean number of visits: • Success: 10.1 + 17.8 visits • Non-success: 8.7+ 4.5 visits

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Monitoring patient demographic data, outcome measures and prioritized interventions can inform clinical practice. The use of both the FAAM and NPRS is warranted for measuring clinical success. No agreement exists concerning the cut-off scores used to determine successful outcomes. Most clinical prediction rules have used a 50% as the cut-off value and this could be used in future studies in this area.

References: 1. McPoil TG, RL Martin, MW Cornwall, et al. Heel pain-plantar fasciitis: Clinical Practice Guidelines. JOSPT. 2008;38(4): A1-18. 2. Martin R. Evidence of validity for the foot and ankle ability measure (FAAM). American Orthopaedic Foot and Ankle Society. 2005;26(10):979. 3. Whitman JM. Predicting Short-Term Response to Thrust and Nonthrust Manipulation and Exercise in Patients Post Inversion Ankle Sprain. JOSPT. 2009;39(3):188-200.