Psychologically Informed Physical Therapy with a Breast Cancer Survivor: A Case Report

Background: Psychologically informed practice has been used in the physical therapy setting for multiple years, particularly with patients experiencing chronic pain. Psychologically informed practice attempts to address the behavioral consequences of pain and encourages the patient to pursue valued activities despite pain. The purpose of this case report is to demonstrate how psychologically informed physical therapy practice was incorporated into the treatment of a patient with psychological comorbidities and a recent episode of breast cancer. Case Description: The patient was a 65-year-old female who was referred to physical therapy to improve shoulder range of motion following breast reconstruction surgery. The patient presented with a history of breast cancer and reconstruction surgery, as well as anxiety and depressive disorders. Educational, cognitive-behavioral, psychophysiological, and contextual cognitive-behavioral approaches that targeted her psychological symptoms and pain-related behaviors were incorporated in a plan that aimed to improve shoulder and abdominal strength and range of motion to enhance the patient’s functional abilities as she prepared for an upcoming move. Outcomes: The patient improved with regards to her shoulder range of motion, patient-specific functional scale measure and subjective aerobic endurance by the end of treatment. She did not demonstrate clinically significant pain catastrophizing or kinesiophobia by the end of treatment, but longitudinal changes could not be evaluated. The patient was able to successfully pack and complete her move and had plans to return to some of her valued activities. Discussion: Future research in psychologically informed physical therapy could focus on exploring outcomes in varied patient populations, determining effective standardized and replicable approaches, and establishing clearer determinations regarding effectiveness in a variety of patient populations.