In the process of limb lengthening and deformity correction, the bone lengthens or is realigned at a rate up to 1 mm per day, which is much faster than a bone would grow naturally. This rapid growth places a challenge on soft tissues to include skin, muscle, tendons, fascia, vascular structures and nerve tissues. Tightness of these structures can lead to joint contracture, joint subluxation, joint dislocation or even nerve damage. Physical therapy (PT) is needed to promote movement and provide stretching to increase the length of the soft tissues in order to facilitate safe limb lengthening. Without aggressive PT, this process will fail. During the deformity correction and/or limb lengthening process, the patients and families are required to adhere to these aggressive PT rehabilitation regimens to achieve successful outcomes. For many reasons outside of tissue generation, patients may fail to reach optimal outcomes.
This prospective study seeks to better understand biopsychosocial factors that are associated with an increased risk for poor rehabilitation outcomes during PT in this patient population. The study will consist of two arms; arm 1 involves the identification of risk/factors and arm 2 involves identification of therapeutic interventions to promote successful rehabilitation outcomes. After the data collection is completed, investigators and authors will use SPSS21 to analyze comparisons to identify potential risk and protective factors for successful limb-lengthening outcomes. Once these factors are identified, Arm 2 will focus on the identification of therapeutic interventions to promote successful rehabilitation outcomes. These individualized interventions will be informed by the use of screening measures during an initial brief intake prior to the start of physical therapy.
The significance of the proposed study will include the enhancement of care and promotion of successful rehabilitation outcomes in pediatric and adult limb-lengthening patient populations, utilizing a rehabilitation model of collaborative patient care.