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More Than Meets the Eye: Clinical Reflection and Evidence-Based Practice in an Unusual Case of Adolescent Chronic Ankle Sprain

Mohamed Mohamed, Christopher Kevin Wong
DOI: 10.2522/ptj.20110033 Published 1 September 2011
Mohamed Mohamed
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Christopher Kevin Wong
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Abstract

Background and Purpose Adolescents who have chronic pain after common orthopedic injuries such as ankle sprains may present a multidimensional clinical problem stemming from both physical and psychological issues. A traumatic incident such as a motor vehicle accident can produce clinical issues ranging from a specific tissue injury to multisystem complications such as complex regional pain syndrome (CRPS) or posttraumatic stress disorder (PTSD). The purpose of this retrospective case report on an adolescent with chronic ankle pain stemming from a motor vehicle accident is to demonstrate how reflection and the evidence base influenced the modification of the plan of care. Description of the screening methods, clinical findings, interventions, and outcomes of the case may help physical therapists identify and improve the quality of care in cases of suspected CRPS and PTSD.

Case Description The patient was a 12-year-old girl with a medical diagnosis of recurrent right ankle sprain and with signs of potential CRPS and PTSD. Poor initial response to ankle sprain management led to reflective reconsideration of the diagnosis and plan of care. The revised plan of care supported by the evidence base emphasized empathetic consideration of the traumatic motor vehicle accident and focused on CRPS prevention and management of potential non-physical pain via mirror therapy and motor imagery therapy.

Outcomes Pain was relieved, behavior improved, and functional movement began to normalize after 3 sessions of mirror therapy and motor imagery therapy.

Discussion Patient symptoms were inconsistent with the medical diagnosis, and the clinical outcome of the original plan of care was unsuccessful. Reflection inspired a more-detailed history and systems review, which led to greater understanding and more-effective care.

Footnotes

  • Both authors provided concept/idea/project design and writing.

  • This work was completed while Dr Mohamed was a Doctor of Physical Therapy student in training.

  • Received February 2, 2011.
  • Accepted May 7, 2011.
  • © 2011 American Physical Therapy Association
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Vol 96 Issue 12 Table of Contents
Physical Therapy: 96 (12)

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More Than Meets the Eye: Clinical Reflection and Evidence-Based Practice in an Unusual Case of Adolescent Chronic Ankle Sprain
Mohamed Mohamed, Christopher Kevin Wong
Physical Therapy Sep 2011, 91 (9) 1395-1402; DOI: 10.2522/ptj.20110033

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More Than Meets the Eye: Clinical Reflection and Evidence-Based Practice in an Unusual Case of Adolescent Chronic Ankle Sprain
Mohamed Mohamed, Christopher Kevin Wong
Physical Therapy Sep 2011, 91 (9) 1395-1402; DOI: 10.2522/ptj.20110033
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More in this TOC Section

  • Acute Inpatient Rehabilitation Interventions and Outcomes for a Person With Quadrilateral Amputation
  • Development of an International Clinical Education Extracurricular Experience Through a Collaborative Partnership
  • Systematic Clinical Reasoning in Physical Therapy (SCRIPT): Tool for the Purposeful Practice of Clinical Reasoning in Orthopedic Manual Physical Therapy
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  • Pain
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