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Case Study 1
Case Study 1 - Mr AR
Alain was a 45 year old Investment Banker working in the City of London when his scooter was struck by a van on 3rd November 2018. He suffered a closed, comminuted fracture of the left patella that required surgical fixation and was in hospital for 9 days.
Prior to his accident, Alain was fit & healthy and very physically active, enjoying football & tennis once a week, as well as golf and road running. He lived with his wife (who was pregnant at the time of index injury) and their young son in Chelsea on the top two floors of a 7-storey building with several flights of stairs to access the property & internal stairs to navigate. Given his home situation, Alain was unable to return home following discharge from hospital and instead had to move into a friend’s flat and then to a rental property.
As a result of his injury, Alain was required to wear a leg brace fixed in extension (ie. unable to bend his knee) for 2 months. Furthermore, he was not allowed to fully weight bear for 4 months.
On 25 November 2018 (13 days after his discharge from hospital), Remedy Healthcare performed a community-based assessment to plan Alain’s rehabilitation. His personal, long term goals at the time included:
to return to all his previous sporting activities, including golf, running, skiing, tennis and football;
to return to full time work following a period of rehabilitation;
to take his son skiing without fear of injuring his knee further.
On 4 December 2018 a community-based physiotherapy and occupational therapy programme was initiated. Alain remained non-weight bearing (NWB) for 3 months and then PWB for a further month. Whilst living at the rental property, Alain’s wife and son visited regularly to help with washing, cooking and cleaning and preparing food for Alain to eat whilst living alone. Alain required assistance from his wife to set up his shower to wash, to dry and to dress his lower body due to difficulty with reaching his left foot. His sleep was disrupted due to pain. this stage, he was only able to mobilise up to 20 metres with two elbow crutches, non-weight bearing with the knee in an extension splint. He was considered to be unsafe on the stairs independently.
By mid-January 2019 Alain was able to return home using crutches and assistance on stairs. Only by 26 February 2019 (4 months post-injury) was he permitted to fully weight bear (FWB) & actively flex his knee.
Following this progression to FWB, and in order to accelerate Alain’s progress and enable him to achieve his goal of returning to work, he was admitted for a period of high intensity, residential rehabilitation on 11 March 2019. After 13 days of intensive rehabilitation, Alain was able to increase flexion in the knee from 90 to 130 degrees and able to walk confidently without the use of walking aids.
In early April 2019 Alain returned to work, including commuting from Chelsea to the City. By the end of April 2019, he was walking 7 miles comfortably without crutches. Alain continued his community-based physiotherapy programme until September 2019.
In February 2020 Alain sent this photograph from his family skiing holiday – another personal goal achieved.
Alain’s case illustrates several important aspects of effective specialist MSK rehabilitation:
Early intervention is key – Alain was assessed by a specialist team only 3 weeks following injury.
Timing & intensity of delivery of rehabilitation makes the difference – Alain underwent a carefully timed period of high intensity, residential rehabilitation as soon as he was able to FWB (clinical ‘bio’ reason) and to prepare him for his return to work (socio-economic ‘psycho-social’ reason).
The complexity of a client’s needs with regard to specialist rehabilitation are not determined solely by the nature of the injuries, but by the context in which they occur – Alain only had a ‘single fracture’ but this had a significant impact on his home & work life over many months.
Rehabilitation should always be client goal-focussed – Alain was enabled to achieve the objectives that he set & that were important to him.
The combination of motivation & opportunity can deliver extraordinary outcomes – Alain was engaged and highly motivated throughout his recovery and was given access to the expertise & support he needed to achieve his goals.
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