At my orthopedic outpatient practical placement I came across a 43 year old woman who has had a right Total Knee Replacement 7 months ago. Her rehabilitation has been going very slow and she’s still walking with one, sometimes two crutches.
When I first assessed her it wasn’t so much her right knee that seemed to be hindering her in her gait so much as the malalignment of her left lower extremity. She’s got a very strong valgus knee and pronation of her foot to the stage where she’s practically weightbearing on her medial malleolus. The patient told me that her left ankle and knee will be up for surgery as soon as possible.
The biggest factor for her joint problems is most likely a result of the patient being heavily overweight.
Being a physiotherapy student and knowing about the relationship of obesity and knee osteoarthritis the first thing I could think of was: this patient needs to lose weight.
So I approached the obvious and suggested the patient would start going to the pool. She could do her knee exercises in the water and at the same time getting a good work out without putting a lot of stress on her joints.
My patient wasn’t too happy about this suggestion and replied she didn’t want to go to the pool with all those skinny people. Well...
From my point of view the only way this patient could do aerobic exercise to help her losing weight would either be in the pool or on an ergometer, which she isn’t willing to do.
How could I motivate her to get out there and tackle her weight? Has anyone come across similar situations and how did you handle it?
Edith
2 comments:
Edith,
When I was on my outpatient clinic we had a few cases similar to yours. One major thing that I found the 'weight' issue easier to tackle is if the doctor had discussed it first!! I remember one time it was written in the medical records that the weight loss had been discussed and I approached it from the viewpoint...'I see in the notes that you discussed weight loss with your doctor', that opened it up and thankfully the pt was able to tell me what she was doing and was readily available for suggestions. It was also written on several referrals for us - so that made things a lot easier.
If you can't see if it has been discussed with the medical staff, perhaps a phone call to them might be a good starting point...surely they wouldn't do extensive bilateral surgery without having discussed weight loss with the pt.
Other things....if you have a list of local pools near where the pt lives/around the hospital, you could get information from the make up of the aerobics groups...or suggest she goes with a friend?? Or...tee up a phone call with the instructor of the group to try and make her more comfortable? Really......not to be awful....but I think very few 'skinny' people go to hydrotherapy sessions! Maybe attack it from that viewpoint!
I think you're doing really well to be sensitive about it....and as a 'younger' 'skinnier' person, it is hard. My ?50 yr old supervisor could just say something like 'and about your weight....' which worked really well for her, but I don't think would go down too well coming from a younger person :).
Good luck with it...hope some of this helps!
Mads
Hi Edith,
There is no an easy way to say someone that he or she is overweight, my suggestion would be to find out what patient is willing to do in terms of exercises or would like to do. Lets say if she likes bike riding, this type of aerobic exercise would help her to loose weight without putting too much pressure on the knees. In addition, if she has a friend who is in the some situation, going together to the pool your patient may feel more comfortable as she would not feel as she is the only overweight person. Anyway, good luck and hopefully this may give rise to the better thoughts addressing this situation.
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