Abstract
A 69-year-old-female patient with severe coronary artery stenosis underwent coronary artery bypass grafting of 3 vessels and aortic valve replacement via median sternotomy was seen for physical therapy evaluation and treatment provided by a student physical therapist under the supervision of a licensed physical therapist. The patient spent 17 days in an inpatient hospital and was seen for 14 physical therapy sessions. The patient was evaluated at the initial encounter with the 5 Times Sit to Stand, Numeric Pain Rating Scale, 4-Meter Gait Speed, Physical Function ICU Test, Activity Measure of Post-Acute Care “6-clicks,” 2-minute Walk Test, the Patient Health Questionnaire and Wells Criteria for deep vein thrombosis. A plan of care was established to address the patient’s strength deficits, decreased activity tolerance, and limited functional mobility. Main physical therapy goals for the patient included independent ambulation with appropriate assistive device, bed mobility with minimal assistance and completion of transfers with stand-by assistance to increase the patient’s participation goal of knitting and reading while in the hospital. The patient’s chief complaint was sternal incision pain and assistance required for all functional mobility. Main interventions included progressive bed mobility, ambulation training, and therapeutic exercises while maintaining sternal precautions. The patient exceeded the minimum detectable change for lower extremity strength, gait speed, and basic mobility, and exceeded the minimally clinically important difference for physical function. The patient was discharged to a skilled nursing facility to continue improving in all functional mobility due to her lack of social support and poor activity tolerance necessary to achieve her goal of returning home and performing her normal activities of daily living, including caring for her cat.