Patient Education Handouts Patient Education Handouts and Home Exercise and Home Exercise

Programming for the Programming for the Orthopedic and Juvenile Orthopedic and Juvenile

Rheumatoid Arthritis Rheumatoid Arthritis population. population.

Tia Barbour-HaleTia Barbour-Hale

Mandy D’AmourMandy D’Amour

Donna TrotterDonna Trotter

QuestionQuestion

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

Goals for CQI 2008-2009Goals for CQI 2008-2009

• Provide families with increased education Provide families with increased education through handouts, specifically for the JRA through handouts, specifically for the JRA and orthopedics diagnoses.and orthopedics diagnoses.

• Develop home exercise programs for most Develop home exercise programs for most commonly seen orthopedic diagnoses.commonly seen orthopedic diagnoses.

• Improve consistency of home programs Improve consistency of home programs and education provided to families. and education provided to families.

ProcessProcess

• Compiled a list of most commonly seen Compiled a list of most commonly seen diagnosesdiagnoses

• Literature review on available education Literature review on available education and protocols for the above diagnosesand protocols for the above diagnoses

• Developed format for education handoutDeveloped format for education handout

• Assembled data according to format for Assembled data according to format for handout and home exercise programshandout and home exercise programs

• Printed and educated practitioners for clinic Printed and educated practitioners for clinic useuse

Most Commonly Seen Most Commonly Seen Diagnoses AddressedDiagnoses Addressed

• Elbow FractureElbow Fracture

• Brachial Plexus InjuryBrachial Plexus Injury

• Ankle SprainAnkle Sprain

• Low Back PainLow Back Pain

• Patellafemoral PainPatellafemoral Pain

• Hip PainHip Pain

• Shoulder PainShoulder Pain

• JRA (lower and upper extremity joints)JRA (lower and upper extremity joints)

Education Handout ExampleEducation Handout Example

• Elbow Fracture Elbow Fracture • Information for Parents & CaregiversInformation for Parents & Caregivers• How are elbow fractures caused?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 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 outstretched arm, falling directly on the elbow, direct blow to the elbow, or twisting the elbow beyond the elbow's normal range of motion.range of motion.

• SymptomsSymptoms• Symptoms include pain, often severe, tenderness, swelling, and bruising around the elbow, numbness in fingers, hand, or 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 sitelower arm, decreased range of motion, a lump or visible deformity over the fracture site• Treatment Treatment • Treatment will depend on the severity of the injury. Treatment involves putting the pieces of the bone back in position, 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.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 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)surgery), a metal plate with screws (requires surgery), and screws alone (requires surgery)• Rehabilitation for Elbow FractureRehabilitation for Elbow Fracture• A therapy program usually begins with range-of-motion and resistive exercises, then incorporates power, aerobic and 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 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 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 elbow fracture, once it's healed, are to improve the elasticity of the elbow joint and to gradually increase pain-free range of motion.of motion.

• How long will the effects of an injury last?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 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 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 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 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.will obviously create a longer recovery period than patients with a Type I fracture.

• ReferencesReferences• Ashwood N, Bain G, Unni R. Management of Mason Type – III radial head fractures with a titanium prosthesis, ligament Ashwood N, Bain G, Unni R. Management of Mason Type – III radial head fractures with a titanium prosthesis, ligament

repair, and early mobilization. repair, and early mobilization. J Bone Joint Surg.J Bone Joint Surg. 2004;86:274-80. 2004;86:274-80.• Ikeda M, Sugiyama K, Kang C, Takagaki T, Oka Y. comminuted fractures of the radial head. Ikeda M, Sugiyama K, Kang C, Takagaki T, Oka Y. comminuted fractures of the radial head. J Bone Joint Surg.J Bone Joint Surg. 2005;87: 76- 2005;87: 76-

84.84.

For the FutureFor the Future

• Continue to add diagnoses as they Continue to add diagnoses as they become common in the clinicbecome common in the clinic

• Take current handouts and HEPS and Take current handouts and HEPS and make changes according to most available make changes according to most available researchresearch

• Continue to educate practitioners in the Continue to educate practitioners in the clinic about these diagnoses clinic about these diagnoses

• Make these handouts a part of the Make these handouts a part of the orientation manuals orientation manuals