Writing – Case 1
Description: PW is a 65-year-old man I had the chance to meet at a
physiotherapy clinic, he has had knee osteoarthritis (OA) from a very early
had come in to the clinic for a check-up as three weeks ago, he had a left
total knee replacement (TKR), which was still in the process of healing. Last
year, he also had a right TKR.
since he could walk, he loved playing football, and as a teenager he was talented
enough to play for a professional football club. He sustained many knee
injuries throughout his time on the field, however, he was only ever treated
with analgesic injections or painkillers with the sole aim of getting him back
on the pitch. The repeated trauma to his knees meant that at the age of 17, he had
a significant portion of meniscal cartilage removed from his right knee. Over
time, his knee OA became so severe that he had to give football up and instead,
he became a legal executive.
Feelings: I was feeling a little nervous as it was the first time I would be
left alone with a patient but having my peers with me in the room made me feel
more at ease. Something that also added to my nerves was the fact that I wanted
to make sure I had covered all the topics the physiotherapist had asked me to
discuss with the patient. At the same time, however, I also wanted to have a genuine
conversation with the patient and it was hard trying to balance all the
criteria at first.
I found it upsetting that he had to spend such a significant amount of his life
in constant pain and discomfort. I admired the attitude of perseverance and
stoicism that he had developed over all those years despite the fact that he
had a chronic illness.
was unsure why his doctors would decide to remove so much cartilage knowing the
impact it would have on PW in his later life. I remember learning in a clinical
skills session that meniscectomies were a common method used to treat knee OA in
the past, but it was something rarely performed today.
Reflection: I learnt how integral the role of physiotherapy is in a patient’s post-operative
plan. In a way, for the patient, the surgery is the easy part, it is often the
long recovery period that is the hardest.
now appreciate that physiotherapy is very patient-centred, the patient sets
their own goals and the physiotherapist helps them manage their expectations. For
example, all PW wanted was the chance to be able to play football with his grandchildren.
For him, the occasional discomfort or pain is something he can manage
independently. This was something I came across a lot during my time as a ward
volunteer at my local hospital, for many patients, their idea of a full
recovery was very goal-orientated, whether that meant simply being able to
drive again or take their dog on a walk.
meeting PW, I had not taken into consideration the long-term effects chronic
pain can have on a patient’s mental health. PW has struggled with depression during
the last ten years and this was something he believed was as a result of the physical
limitation caused by his knee OA. It was only when I put myself in his shoes
that I began to fully comprehend the immense impact that the stress and pain he
often endured in his day to day life must have on his mental wellbeing. An
article by Sharma et al. highlighted to me that psychological comorbidities
such as anxiety and depression are “highly prevalent among patients with OA”.
Although I had deep empathy for him, I feel as though I could have expressed my
empathy more verbally by reassuring him.
Conclusion: I was eager
to find out if there were any long-term treatments for knee OA other than TKRs.
I came across an article by McAlindon et al., (2018) which details the use of
new delivery systems such as “poly(lactic-co-glycolic acid) microspheres” which
“can prolong the action of glucocorticoids… in joints for several months” (usually
“their analgesic effect declines within 2–4 weeks”, McAlindon et al., (2014)).
I had not previously considered the link between participation in a contact
sport and weight-bearing joint health. I learnt that knee OA has been shown to
be “more prevalent” among former football players and “particularly elite
players” in a study by Roos et al.,(1994).
had to wear compression tights after his TKR to help venous return in his legs.
This was something I was intrigued by and I read that Lotke et al., (1984) had
found that the relative risk of DVT after a TKR increased with age. This made
me appreciate that such a simple and cost-effective tool such as compression
tights could go a long way in reducing the risk of a potentially life-threatening
Action Plan: In regard to the consultation, I think I felt overwhelmed in the
beginning because I expected to be leading the conversation. I learnt that it
was more productive to take a step back and, in the future, I will let the
patient set the pace of the conversation since I will be able to get more
information from the them this way.
will consolidate my knowledge of joint examinations such as GALS test by using
the online tutorials provided on Learning Central as well as practising them
with my peers and asking for constructive feedback.
will also read more about the adverse drug reactions of glucocorticoids as
their overuse has been linked to osteoporosis. I will do this by using PubMed
to find any research on this topic and selecting texts which are suitable to my
current level of understanding.