Physical Therapy Management of Acute Polymyositis: A Case Report

Introduction: Polymyosits (PM) is a rare systemic disease, which is typically a diagnosis of exclusion. Due to the rarity of this disease, there is little published research regarding the physical therapy management of this condition, particularly during the acute stages. This case report outlines one approach taken during the management of a patient with PM in an inpatient rehabilitation facility (IPR) and documents his steps towards functional improvement during his stay. Patient History: A 41-year-old African American man presenting with the diagnosis of PM with reports of progressive weakness and an inability to fully lift his head or ambulate independently. He also suffered from frequent falls, one of which resulted in an emergency department visit, where his episode of care began. Diagnoses: Rheumatology diagnosed this patient with PM based on: elevated creatine kinase levels in his blood; electromyography showed irritative myopathy; observed symmetric proximal muscle weakness and absence of a skin rash. Muscle biopsy results were pending during his entire episode of care. Interventions: Intense physical therapy interventions were focused on regaining function, building strength, and reducing secondary complications of hospitalization. Outcomes: After 25 days in inpatient rehabilitation, the patient demonstrated improvements in the five times sit to stand test, lateral reach test, and manual muscle testing. The patient also demonstrated reduced burden of care and improved functional mobility. Discussion: This case presented therapeutic challenges for the rehabilitation staff due to the severity and acuity of the disease process. This case report provides one example of the safe use of intense physical therapy interventions for the rehabilitation of a severe, acute case of PM. This case report suggests physical therapy interventions may improve functional mobility even in this acute stage of the disease.