The Role of Clinical Decision Making During the Acute Management of an Adolescent Patient with an Unusual Presentation of Rhabdomyolysis: A Case Report

Background and Purpose: The current opioid epidemic facing the United States has brought with it increased rates of morbidity and mortality. One such condition that can develop following inappropriate opioid use rhabdomyolysis. Limited research exists on the role of physical therapy in non-exertional rhabdomyolysis, especially in the acute care setting. The purpose of this report was to describe the physical therapy treatment of non-exertional rhabdomyolysis in the acute care setting and determinants impacting decision making.Case Description: The patient was a 17 year-old female that developed rhabdomyolysis following illicit drug use. The patient presented with decreased lower extremity strength, sensation, and functional mobility. Interventions focused on ambulation, neuromuscular re-education and patient education. The framework of decision making in acute care described by Jette was employed to guide interventions and discharge planning.Outcomes: The patient completed nine physical therapy sessions while in acute care. Improvements were seen in lower extremity strength of hip flexors and knee extensors, a 0.393 m/s improvement gait speed (MCID 0.16 m/s) in the 10 Meter Walk Test, a 205.74 m improvement in gait distance in the 6 Minute Walk Test and greater independence with functional mobility. Recommendation for inpatient rehabilitation remained throughout due to several factors, however insurance denied the request.Discussion: This report highlights the role of physical therapy in a unique case of rhabdomyolysis. Due to the limited research on treatment and prognosis, various factors were considered to guide intervention selection and discharge recommendation. Further research regarding specific treatment and the role of societal factors impacting long-term outcomes following drug-related rhabdomyolysis is needed.