Determining a Clinical Endpoint for a Patient with Bilateral BKA, Electricity-Induced SCI, and Workers’ Compensation Involvement: A Case Report

Purpose: The purpose of this case report is to present the difficulties in the decision-making process for when to end physical therapy for a patient with an electricity-induced spinal cord injury, amputations, and workers’ compensation involvement. Background: Prognostic decision-making to determine a clinical endpoint for physical therapy is challenging for patients with chronic conditions. It is further complicated for patients with multiple diagnoses. This concept of multiple comorbidities interacting in a negative manner is known in research as multimorbidity and it can significantly complicate the prognosis.²Case Description: The patient was a 58-year-old construction worker that suffered a traumatic electrical injury approximately 2 years ago. The injuries resulted in bilateral below-knee amputation, significant soft tissue damage, and electricity-induced myopathy leading to bilateral upper and lower extremity weakness and spasticity. Outcomes: The primary outcome measures used in this case were static balance (feet shoulder width apart with eyes open), the Timed Up and Go^9,10, the 10 Meter Walk Test⁹, the 30 second Sit to Stand Test, and the 6 Minute Walk Test.^9,11 The patient was seen over the course of 2 years for more than 270 visits. Discussion: Due to the complex interactions of the comorbidities represented in this case, traditional prognostic indicators that have been supported in research are not always effective ways to determine a clinical endpoint. There is no objectively correct time to end therapy with a patient. That decision will always require a skilled therapist to make a judgement based on the available research, their clinical experience, and the personal factors unique to each patient.