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CPTE Oral Hip Fracture Case Scenario Practice

Acute care orthopaedic case involving post-operative hip fracture rehabilitation, COPD-related ventilatory limitation, Parkinson’s disease, discharge planning, interprofessional collaboration, and ethical management of family expectations.

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Case Scenario

Hip Fracture Case Details

Review the full written case in a table-style format before attempting the oral questions.

Client Profile
Client Name Mrs. Eleanor T. Practice Setting Acute care hospital – orthopaedic ward
Age 76 years Post-operative Status Post-operative Day 2
Gender Female Reason for Admission Fall at home resulting in a left hip fracture; surgical fixation completed.
Subjective Information
Reason for Admission Mrs. T. was admitted following a fall at home, resulting in a left hip fracture. She underwent surgical fixation and is currently post-operative Day 2.
Medical History
  • Chronic Obstructive Pulmonary Disease (COPD), diagnosed 12 years ago.
  • Uses inhalers regularly.
  • Two hospital admissions in the past year for COPD exacerbations.
  • Parkinson’s disease, diagnosed 8 years ago.
  • Hypertension, well controlled.
Current Respiratory Status
  • Shortness of breath with minimal exertion.
  • Chronic productive cough.
  • Intermittent wheezing.
  • Fatigue with bed mobility.
  • Oxygen saturation borderline low on room air.
  • Sleeps propped up on pillows at home.
Neurological Status
  • Bradykinesia and rigidity.
  • Reduced balance.
  • Shuffling gait prior to admission.
  • Required walker for short household ambulation.
Social History
  • Lives with her daughter in a bungalow.
  • Daughter is the primary caregiver.
  • Required supervision for bathing and dressing prior to the fall.
  • Independent with feeding, but slow.
  • Daughter strongly wants Mrs. T. to “walk independently again and manage everything like before.”
  • Daughter reports that Mrs. T. is “much weaker than before.”
  • There is concern that Mrs. T. may not regain her previous level of function.
CPTE oral cue: The family’s expectations are clinically important because they affect education, goal setting, discharge planning, consent, and therapeutic alliance.
Pre-Admission Functional Status
  • Ambulated short distances with walker.
  • Limited endurance due to COPD.
  • Required occasional assistance with transfers.
Current Functional Status
  • Requires maximal assistance for bed mobility.
  • Unable to stand independently.
  • Significant pain in left hip.
  • Increased breathlessness during repositioning.
  • Appears fatigued and deconditioned.
Presenting Complaint
  • Severe left hip pain with movement.
  • Difficulty breathing during repositioning and minimal activity.
  • Persistent cough with sputum.
  • Fatigue and weakness.
  • Fear of moving due to pain and breathlessness.
  • Her daughter reports that Mrs. T. is “much weaker than before” and is worried she will not regain her previous level of function.
Pain Characteristics
Location Left hip Severity / Behaviour Severe with movement
Functional Impact Fear of movement, limited bed mobility, difficulty repositioning.
Objective Information
  • Shortness of breath with minimal exertion.
  • Chronic productive cough.
  • Intermittent wheezing.
  • Fatigue with bed mobility.
  • Oxygen saturation borderline low on room air.
  • Sleeps propped up on pillows at home.
  • Bradykinesia and rigidity.
  • Reduced balance.
  • Shuffling gait prior to admission.
  • Required walker for short household ambulation.
Candidate focus: This is a multi-system acute care case. Link the orthopaedic, respiratory, neurological, functional, caregiver, and discharge-planning issues together rather than answering as separate isolated problems.
Clinical Impression Prompt
What is your clinical impression for this patient?

Summarize the key multi-system impairments, risks, functional prognosis, and realistic rehabilitation priorities for Mrs. T. in the acute post-operative hospital setting.

Reveal Clinical Impression Answer

Mrs. T. presents with complex, multi-system impairments including post-operative left hip fracture, chronic COPD with ventilatory limitation, and Parkinson’s-related bradykinesia and balance deficits.

Her respiratory compromise increases risk of post-operative pulmonary complications, while Parkinson’s disease contributes to reduced motor control and impaired mobility recovery. The interaction between pain, deconditioning, ventilatory limitation, and neurological impairment significantly impacts her functional prognosis.

Given her reduced pre-admission mobility and chronic disease burden, realistic rehabilitation goals must focus on safe mobility, prevention of complications, caregiver education, and appropriate discharge planning, rather than full functional independence.

Section 8

Oral Questions

Question 1

1.A Describe the best physiotherapy approach in the acute post-operative hospital setting.

1.B Explain precautions and modifications required due to COPD and Parkinson’s disease.

Question 2

Mrs. T. lives in a bungalow with 4 steps to enter the home with no railing. Once inside, she is set up on the main level, with a regular-height bed and standard toilet.

2.A Identify key members of the multidisciplinary team involved in preparing this patient for discharge home.

2.B Describe how interprofessional collaboration supports a safe and realistic discharge plan.

Question 3

The daughter insists that her mother must return to fully independent walking and ADLs, despite significant pre-admission mobility limitations from Parkinson’s disease and COPD.

3.A Describe how you would establish realistic, patient-centered goals for recovery.

Section 9

Answer Keys

Reveal Answer Key: Question 1

1.A – Best Physiotherapy Approach in Acute Post-Operative Setting

1. Early Mobilization

  • Bed mobility training.
  • Sit-to-stand practice.
  • Transfer training.
  • Ambulation with appropriate aid, likely walker.

2. Respiratory Management for COPD

  • Deep breathing exercises.
  • Thoracic expansion exercises.
  • Incentive spirometry, if indicated.
  • Supported coughing and huffing.
  • Early upright positioning.
  • Monitor SpO₂, Borg RPE, and dyspnea scale.

3. Parkinson’s-Specific Strategies

  • External cueing using visual or verbal cues.
  • Rhythmic counting for movement initiation.
  • Large-amplitude movement training.
  • Allow extra time for transitions.

4. Functional Strengthening

  • Sit-to-stand repetition.
  • Lower limb strengthening within surgical precautions.
  • Balance retraining as tolerated.

5. Education

  • Energy conservation.
  • Breathing control, including pursed-lip breathing.
  • Fall prevention.
  • Safe use of gait aid.

1.B – Precautions and Modifications for COPD and Parkinson’s Disease

COPD Precautions

  • Avoid overexertion.
  • Monitor oxygen saturation.
  • Use pacing and rest breaks.
  • Avoid supine positioning if dyspneic.
  • Watch for cyanosis, excessive fatigue, and increased work of breathing.

Parkinson’s Modifications

  • Avoid dual-tasking early.
  • Reduce environmental clutter.
  • Use simple, clear instructions.
  • Anticipate freezing and use floor markers or cueing.
  • Emphasize safety during turning.

Combined Considerations

  • High fall risk.
  • Reduced endurance.
  • Slow motor responses.
  • Increased fatigue.
Reveal Answer Key: Question 2

2.A – Key Multidisciplinary Team Members

  • Physiotherapist
  • Occupational therapist
  • Nurse
  • Respiratory therapist
  • Physician / geriatrician
  • Pharmacist
  • Social worker

2.B – Importance of Interprofessional Collaboration

  • Ensures medical stability before discharge.
  • Aligns functional goals with realistic outcomes.
  • Prevents readmission.
  • Reduces fall risk.
  • Supports caregiver education.
  • Ensures equipment is in place before discharge.

Effective communication prevents fragmented care and promotes safe, patient-centered discharge planning.

Reveal Answer Key: Question 3

3.A – Establishing Realistic, Patient-Centered Goals

1. Involve the Patient

  • Ask: “What is most important for you at home?”

2. Use SMART Goals

  • Specific.
  • Measurable.
  • Achievable.
  • Relevant.
  • Time-bound.

Example Goals

  • Ambulate 15–20 metres with walker and supervision.
  • Independently transfer bed-to-chair.
  • Climb 4 steps with assistance.
  • Perform basic ADLs with adaptive equipment.

Focus on:

  • Safety.
  • Quality of life.
  • Energy conservation.
  • Functional independence within realistic limits.
Section 10

Textbook & Professional References

  • Pryor JA, Prasad SA. Physiotherapy for Respiratory and Cardiac Problems. 5th ed. Elsevier; 2020.
    Use for: COPD physiotherapy management, airway clearance, and respiratory exercises.
  • Kisner C, Colby L, Borstad J. Therapeutic Exercise: Foundations and Techniques. 7th ed. F.A. Davis; 2024.
    Use for: mobility, transfers, strengthening, and functional exercise post-hip fracture.
  • Dutton M. Dutton’s Orthopaedic Examination, Evaluation, and Intervention. 6th ed. McGraw-Hill; 2017.
    Use for: post-orthopaedic surgery assessment and functional rehabilitation principles.
  • Canadian Physiotherapy Association (CPA). Code of Ethics & Professional Practice Standards.
    Use for: scope of practice, MDT collaboration, ethics, and informed consent.
  • Global Initiative for Chronic Obstructive Lung Disease (GOLD). Global Strategy for the Diagnosis, Management and Prevention of COPD. 2024 update.
    Use for: evidence-based COPD management, risk stratification, and safe activity pacing.
  • Parkinson’s Foundation / Movement Disorder Society Guidelines.
    Use for: physiotherapy approaches for Parkinson’s disease, balance, gait training, and safety considerations.

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