Date of Award

January 2013

Document Type

Thesis

Degree Name

Medical Doctor (MD)

Department

Medicine

First Advisor

Jonathan N. Grauer MD

Subject Area(s)

Surgery

Abstract

In many areas of orthopedics, it is important to have the tools to adequately evaluate a patient. It is sometimes challenging to obtain and quantify both objective and subjective data that contribute to the entire picture of a patient. The goal of this research was to work toward improvement in the quality of different aspects of patient assessment in orthopedics.

The first project focused on the use of outcomes measures in reference to low back pain and mobility. Pain and disability were assessed using patient-report surveys, including the Visual Analog Scale (VAS) and the Oswestry Disability Index (ODI). Mobility was measured using an electrogoniometer while the patient performed full range of motion as well as simulated activities of daily living. ODI appeared to be a better predictor of motion than VAS and may be more useful in the clinical setting when considering functional movement parameters.

In the second project, we considered the common practice of assigning limited weight bearing to orthopedic trauma patients at a level I, academic trauma center. We first surveyed experienced physical therapists (PTs) to understand common practice in teaching touch-down weight-bearing (TDWB). We then evaluated patients' ability to learn and maintain TDWB at both discharge and first follow-up appointment. We found that there was no standard practice among PTs and patient inter-step variability was extreme. At discharge, a majority of steps were under a desired weight range of 15-35 pounds, while at follow-up, a majority of steps were over the prescribed limit. A standardized and improved system to teach limited weight-bearing is clearly needed to ensure compliance.

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