The Risks of Physical Therapy
One of my previous PT classmates called me a few weeks ago to tell me about an incident she had at work. Over the past few weeks, the situation has developed and the skills of my friend have been put into question. I'd like to hear your input when you are finished reading!
The patient is being seen for physical therapy in an acute-care setting following a total hip replacement. The initial goals and plan of care were outlined and the patient was progressing well. On one particular day, the patient had advanced towards a "Supervision/Contact Guard" level for ambulation and had planned to attempt stairs.
While on the stairs with bilateral railings, the patient's knees buckled and the therapist used the gait belt strongly around the patient's waist to prevent a complete fall. The patient was lowered to a chair and no contact was made with the floor. After the therapy session the patient complained of increased pain in her hip and the nurse was informed of the results to the therapy session. There was never an incident report submitted after the session... because the patient had never actually made contact with the floor.
Two days later the patient had X-rays taken of her hip and it was determined that she would need a surgical revision of her new hip replacement. The patient was very upset and requested the name of the therapist working with her during that session. The MD stated that "the patient never should have been attempting stairs so soon after a hip replacement."
While it cannot be completely proven that the therapy session alone caused the hip injury, most of the caregivers involved believe the patient's hardware loosened during the loss-of-balance episode. It is possible that simply ambulating alone, or rolling/repositioning in the bed may have predisposed the hip to further injury, or maybe the weight-bearing-as-tolerating was too much load for the hip to bear. The end result was that following the stair negotiation, the patient's pain level had increased to an intolerable level and led to further x-rays.
My friend, the therapist, felt confused and targeted. She was simply progressing the plan of care. Every step had been taken to ensure the patient's safety, including a gait belt and a chair kept nearby. The patient had agreed to the therapy session - and attempting stairs - and understood the risks of her surgery. Is the therapist to blame? Should she have been more conservative in her interventions? If the MD didn't want the patient on stairs, shouldn't he have specifically ordered that restriction?
What would you do if you were the therapist in this situation? First, how can you prevent the incident from occurring again with future patients? And how do you resolve the situation with the patient herself? What legal issues do you think this therapist is facing? What rights does the patient have when therapy poses certain risks?