Patient Education Handouts and Home Exercise Programming for the Orthopedic and Juvenile Rheumatoid Arthritis population

1. Patient Education Handouts and Home Exercise Programming for the Orthopedic and Juvenile Rheumatoid Arthritis population. Tia Barbour-Hale Mandy D’Amour Donna Trotter

2. Question • What information is most important to put in a handout for patients and their parents and what exercises should be used for the home exercise program sheets for the most commonly seen orthopedic diagnoses in clinic?

3. Goals for CQI 2008-2009 • Provide families with increased education through handouts, specifically for the JRA and orthopedics diagnoses. • Develop home exercise programs for most commonly seen orthopedic diagnoses. • Improve consistency of home programs and education provided to families.

4. Process • Compiled a list of most commonly seen diagnoses • Literature review on available education and protocols for the above diagnoses • Developed format for education handout • Assembled data according to format for handout and home exercise programs • Printed and educated practitioners for clinic use

5. Most Commonly Seen Diagnoses Addressed • Elbow Fracture • Brachial Plexus Injury • Ankle Sprain • Low Back Pain • Patellafemoral Pain • Hip Pain • Shoulder Pain • JRA (lower and upper extremity joints)

6. Education Handout Example • Elbow Fracture • Information for Parents & Caregivers • How are elbow fractures caused? • An elbow fracture is caused by trauma to the elbow bone(s). Trauma can be caused by: falling on an outstretched arm, falling directly on the elbow, direct blow to the elbow, or twisting the elbow beyond the elbow's normal range of motion. • Symptoms • Symptoms include pain, often severe, tenderness, swelling, and bruising around the elbow, numbness in fingers, hand, or lower arm, decreased range of motion, a lump or visible deformity over the fracture site • Treatment • Treatment will depend on the severity of the injury. Treatment involves putting the pieces of the bone back in position, which may require surgery and keeping the pieces together while the bones heals itself. • Devices that may be used to hold the bone in place while it heals include: a cast or splint (may be used with or without surgery), a metal plate with screws (requires surgery), and screws alone (requires surgery) • Rehabilitation for Elbow Fracture • A therapy program usually begins with range-of-motion and resistive exercises, then incorporates power, aerobic and muscular endurance, flexibility, and coordination drills. As a patient, your number one concern is getting back to full strength as soon as possible so that you can return to normal activity. The major objectives of rehabilitation from an elbow fracture, once it's healed, are to improve the elasticity of the elbow joint and to gradually increase pain-free range of motion. • How long will the effects of an injury last? • The goal of rehabilitation is to return you to your sport or activity as soon as is safely possible. If you return too soon you may worsen your injury, which could lead to permanent damage. Everyone recovers from injury at a different rate. Return to your activity is determined by how soon your elbow fracture recovers, not by how many days or weeks it has been since your injury occurred. It also depends on how serious the injury is. Instances where reconstructive surgery is required will obviously create a longer recovery period than patients with a Type I fracture. • References • Ashwood N, Bain G, Unni R. Management of Mason Type – III radial head fractures with a titanium prosthesis, ligament repair, and early mobilization. J Bone Joint Surg. 2004;86:274-80. • Ikeda M, Sugiyama K, Kang C, Takagaki T, Oka Y. comminuted fractures of the radial head. J Bone Joint Surg. 2005;87: 76-84.

7. For the Future • Continue to add diagnoses as they become common in the clinic • Take current handouts and HEPS and make changes according to most available research • Continue to educate practitioners in the clinic about these diagnoses • Make these handouts a part of the orientation manuals