Faculty Advisor(s)

Kirsten Buchanan

Document Type

Course Paper

Publication Date



© 2016 Jeanine Manubay


Background and Purpose: Cognitive behavioral therapy (CBT) is grounded in the premise that by altering a patient’s negative thought processes, one can improve functional and emotional health. When multiple co-morbidities limit traditional physical therapy interventions, CBT may be a consideration. While CBT has shown benefits in patients with cancer and others, there is a lack of research investigating its effectiveness in conjunction with physical therapy (PT) in the medically complex patient. The purpose of this case report was to document the outcomes of CBT along with traditional PT for a medically complex patient diagnosed with end stage renal disease and multiple co-morbidities. Case Description: The patient, a 51-year-old male, was admitted to a skilled nursing facility after a recent transmetatarsal amputation of the left foot. His medical history revealed multiple chronic diseases including bilateral (BL) foot ischemia, acute osteomyelitis of the L ankle and foot, morbid obesity, diabetes mellitus type 2, vasculitis, chronic dry gangrene on the R foot, peripheral vascular disease (PVD), methicillin-resistant staphylococcus aureus (MRSA), enterocolitis, congestive heart failure (CHF), hypertension (HTN), atherosclerosis, and a previous heart valve replacement surgery. At initial evaluation (IE), he demonstrated a significant decrease in activity tolerance, motivation, and did not report a strong social or family support system. A plan of care (POC) including traditional PT interventions and CBT were introduced. Interventions focused on activity tolerance, strength, balance and coordination training and outcomes measured with timed tolerance to sitting and standing. Outcomes: The patient demonstrated improvements in activity tolerance, trunk control and confidence during sitting and standing activities. Sitting tolerance improved from 1 minute 3s at IE to 30 minutes at discharge. Standing tolerance improved from 28 seconds at IE to 5 minutes and 32 seconds at discharge. His POC was not completed and he was re-admitted to the hospital due to an exacerbation in his medical condition requiring a below the knee (BTK) amputation on his left lower extremity. Discussion: Although it is unclear whether the addition of CBT or traditional PT interventions were the primary factor in the gains made, the patient reported a higher level of confidence and found the inclusion of CBT helpful. Further research is encouraged to investigate the effects of CBT on complex patients and the optimal outcome measures to document its efficacy.


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