University Case Study: Integrated Health Management of Ms. X

This case study focuses on Ms. X, a 42-year-old construction company owner experiencing lower back pain and situational depression. The assignment details her condition, including physical and mental health issues, and provides a comprehensive needs assessment, service planning, and monitoring strategy. The assessment covers both physical and psychological aspects, including spinal and hip assessments, neurological screening, and evaluation of body mass index. The service plan outlines physical exercises, such as lumbar rotation and pelvic exercises, along with cognitive behavioral therapy and counseling to address depression. The monitoring section emphasizes both direct and indirect health assessments, including questionnaires to track progress and identify potential issues. The evaluation phase focuses on analyzing the collected data to make necessary adjustments to the interventions. The case study emphasizes an integrated approach to improve Ms. X's overall health and well-being.

Running head: INTEGRATED CASE STUDY MANAGEMENT
HEALTH CONDITION OF MS. X
Name of the Student
Name of the University
Author Note

1INTEGRATED CASE STUDY MANAGEMENT
Table of Contents
Summary of the Case.......................................................................................................................2
Needs Assessment...........................................................................................................................2
Service Planning..............................................................................................................................2
Monitoring.......................................................................................................................................2
Evaluation........................................................................................................................................2
References........................................................................................................................................3

2INTEGRATED CASE STUDY MANAGEMENT
Summary of the Case
Depression has been defined as a moon disorder which affects most of the Australians who are
admitted to the healthcare sectors each year. One out of five Australians aged in between sixteen
to eighty five years has been found to experience from mental illness every year. This case study
will talk about a similar condition observed in Australian women. Ms X is a 42 years old woman
who owns a construction company. She works both in the office as well as is involved in helping
her crew. Three months ago, Ms X has begun developing Lower Back Pain (LBP). She denied a
Mechanism of Injury MOI and reports has shown that it became constant which made her job
increasingly difficult. In order to control the pain, she has been found to take frequent breaks
during the workday by lying down on her bed. She also feels that her crew were judging her for
not pushing through the pain. She has also reported to deny the fact that her pain was preventing
her from sleeping. This condition was further affecting her ability to run the organisation. She
was hoping that the pain would finally resolve on its own. However, recently she giving up on
trying to get better. She has found that she is getting tired and has been found to report that she
does not care even if the business fails. It has been also reported that recently she is feeling very
depressed and stressful when she is thinking about the business procedure. She is becoming more
and more worried about the business and she have developed a fear by her own that due to her
inability of movement, her business might go through a tremendous loss. This is because of the
fact that she believed that working was the only reason of this pain. She has also been reported to
smoke half a pack of cigarette per day without any outstanding medical history.

3INTEGRATED CASE STUDY MANAGEMENT
Needs Assessment
From the above case study of Ms X, it has been found that the person has both physical and
mental health issues. The physical health issues of Ms X is associated with musculoskeletal
disorder and the identified mental health issue is depression. The outcomes are indicating that the
person is suffer from gross spinal hypo-mobility, low pain self-efficacy and fear-avoidance
influence his daily life.
As per the pain location reported Ms X, she is suffering from lower back pain where the pain is
radiating from lower lumbar position. The major causes of lower back pain usually are disc
injury in lower lumbar area of spine, stains of muscles as well as ligament s die to excess
activity, sciatica involving impact on sciatic nerve, spinal stenosis because of excessive pressure
on spinal nerves, arthritis, spondylitis and spondylosis. Ms X is involved in constructional
business where the prevalence of muscle strain and disc injury is very high. The pain is radiating
from Lower vertebrae and it preventing the person to sleep (Cho et al., 2015). Hence, it could be
the result of disk injury and resulting gross spinal hypo-mobility. As per the current
investigation, Ms X needs clinical assessment for her condition as well as intervention for the
improvement of physical health. For this, Ms X will need clinical assessment of her physical
condition through Active Range of Motion test of Spine, Hip. Neurological screening will
required for testing the neurological involvement in the injury. Body Mass Index should be also
measured in order to identify the impact of her body weight on lumber strain and pressure
(Hartvigsen et al., 2018). In order to control the pain regular exercise will be required along with
lumber rotation and pelvic exercises. A diet chart will be also required to maintain a healthy
body weight with enough nutrient level.

4INTEGRATED CASE STUDY MANAGEMENT
From the case study that Ms X it is not clear that whether she had any history of depression
disorder or other mental health issues. Depressive disorder has different types such as psychotic
depression, Major depression, situational depression disorder, Premenstrual Dysphoric Disorder
(PMDD) and other (Bener et al., 2013). From the case study it has been found that Ms X is
currently facing multiple obstruction in her regular life because of her physical discomfort and
this physical distress preventing her to keep a proper sleep cycle. Along with that she is under a
continuous feelings of stress because of her absenteeism in her business. Hence, her depressive
symptoms are being developed from her stress and worried attitude towards business. Since, this
stress driven digressive symptoms are stimulated from external situation, the depression disorder
can be identified as situational depression disorder. This mental condition can also induce the
hypertension and anxiety symptoms (Gjestland et al., 2013). Disrupted sleep cycle is also
contributing her neuropsychiatric condition. She needs psychological therapies such as cognitive
behavioural therapy and regular counselling to have the level of confidence back. She also needs
healthy diet chart and healthy activity routine to maintain proper sleep cycle. Regular physical
exercise will be also useful for reducing the level of stress and enhancing physical as well as
mental strength.
Service Planning
The service planning for Ms X involves both clinical assessment and interventions. The clinical
assessments will be executed in order to identify the physical and mental health issues from the
core. At the same time the interventions will be provided to keep the person healthy. During the
clinical assessment phase the Ms X will be guided through basic physical exercise and mental
treatment. However, after assessment, when the specific causes will be identified the changes
will be made in both physical and mental interventions.

5INTEGRATED CASE STUDY MANAGEMENT
For physical assessment the AROM assessment will be required where the Active Range of
Motion will be tested for lower lumber area and associated body parts. For Spine AROM lumber
flexion, lumber extension, lumber lateral flexion will be assessed along with lumber rotation
range (Cho et al., 2015). Thoracic flexion and extension assessment will be required along with
thoracic lateral flexion. This assessment will be needed to identify if any obstructive range of
motion is present in the other spinal region except the paining region that is lower lumber. For
this same reason the cervical flexion, cervical extension, cervical lateral flexion and cervical
rotation will be tested. For HIP AROM, flexion, extension, abduction, internal rotation and
external rotation will be tested in order to identify any involvement of spinal nerve injury such as
impact on sciatic nerve, spinal stenosis. Apart from that, SLR test, Step-test, Quadrant test,
Lumbar PA PIVMs will be required for more in depth spinal injury assessment (Moon et al.,
2013).
As clinical intervention for physical condition, different exercises will be added to the daily
routine. Initially the lumber rotation exercise will be used through caudal and cephalic levers at
L3-L4, which with help to relax the muscle fibres associated with lower vertebrae. Rotation
impulse over right L3 transverse process will help the person to improve the rotational flexibility
of lower lumber disks. Quadruped lumbar flexion and extension 3 sets of 10 repetition will be
also required to increase the flexibility and releases the tensions. Supine lower trunk bilateral
rotation 3 sets of 10 repetitions will be added in exercise chart to enhance the rotational
flexibility of bilateral motion (Moon et al., 2013). Prone press ups 3 sets of 8 repetitions will be
added to enhance the strength in thoracic and lumbar associated muscles and tendons. Bilateral
quadruped knee lift 3 sets of 10 repetitions will be added in order to improve the pelvic
flexibility and to strengthen the upper leg muscle associated with gluteus area (Jeong et al.,

6INTEGRATED CASE STUDY MANAGEMENT
2015). Heat and colt treatment will be also added in daily routine where the cold treatment will
allow to reduce pain by decreasing blood flow and heat will allow to increase blood flow to relax
the muscles.
From psychological assessment the history of psychological issues in Ms X will be considered. If
it has been identified that the person is going through situation depression disorder, cognitive and
behavioural assessment will be required to analyse the level of depressive disorder. It has been
previously identified that Ms X has low pain self-efficacy and fear-avoidance that are
influencing her regular life. She lost her hope in recovering current physical complexities and it
resulted multiple negative symptoms of depression disorders. Cognitive behavioural therapy will
be provided to improve her motivation level, confidence level while inducing a happy mood
(Cuijpers et al., 2013). Weekly counselling and psychotherapy will be required for driving her
moods from negative to positive. To change the through patterns and negative actions such as
social withdrawal, negative thought patterns must be reduced. A psychologist and cognitive
behavioural therapist should appointed to for psychoanalysis and psychodynamic therapies. It
has been also found that Ms X is a regular smoker, and therefore she the psychologist should use
cognitive behavioural therapy to control her smoking behaviour so that she could leave her
smoking habit as soon as possible (Richards et al., 2016).
Monitoring
For any healthcare service intervention, monitoring is essential part of health improvement. For
monitoring both direct and indirect health assessment will be required. At the initial stage, Ms X
will be advised to have some clinical examination for both physical and mental conditions in
order to specify the core problems. After developing the long term interventions for both
physical and mental improvement tracking, a health service inspector should visit Ms X’s house

7INTEGRATED CASE STUDY MANAGEMENT
on weekly basis (Foster et al., 2018). The health service inspector should asked about how the
service providers are providing physical and metal care interventions and their regularity. Ms X’s
should be also asked about her physical and mental health improvement level. A score card
system can be used to identify the level of improvement for both physical and mental condition.
Since, Ms X is a regular smoker, the smoking habit should be also monitored and controlled. In
the clinical assessment questionnaire the question about her regular smoking frequency should be
also included to monitor her smoking habit.
The physical condition monitoring questionnaire should include the questions about how often
she is feeling serious pain in lower lumber region, how frequently she found difficulty to fall or
stay asleep, how much difficulties or pain she is experiencing during working hours. For mental
condition assessment, Ms X should be asked about her current motivation level of recovery, her
stress level, frequency of depressive mood, worriedness about business and others. After
collecting the data through longitudinal monitoring by using questionnaire, the scores will be
quantitatively analysed (Parry et al., 2013). The purpose of this analysis it to find any statistically
significant improvement within follow-up sessions for both physical and mental condition.
Evaluation
Evaluation of the monitored data is also essential to make the required changes in the current
interventions. From the collected data and results found from the analysis phase, it will be
identified that if any particular intervention or a set of interventions are causing late recovery or
side-effects in patient’s symptoms. As per the evaluation of the result and the comparative
analysis with current interventions the required changes needed in the existing physical and
mental interventions will be identified. Based on the identified points the exercise procedures
will be changed and the medication will be prescribed if needed. This evaluation procedure is a

8INTEGRATED CASE STUDY MANAGEMENT
long term process where for competition of each month the monitoring data will be collection
from the patients and the evaluation will be made for the further required changes in the clinical
intervention procedures.

9INTEGRATED CASE STUDY MANAGEMENT
References
Bener, A., Verjee, M., Dafeeah, E. E., Falah, O., Al-Juhaishi, T., Schlogl, J., ... & Khan, S.
(2013). Psychological factors: anxiety, depression, and somatization symptoms in low
back pain patients. Journal of pain research, 6, 95.
Cho, I., Jeon, C., Lee, S., Lee, D., & Hwangbo, G. (2015). Effects of lumbar stabilization
exercise on functional disability and lumbar lordosis angle in patients with chronic low
back pain. Journal of physical therapy science, 27(6), 1983-1985.
Cuijpers, P., Berking, M., Andersson, G., Quigley, L., Kleiboer, A., & Dobson, K. S. (2013). A
meta-analysis of cognitive-behavioural therapy for adult depression, alone and in
comparison with other treatments. The Canadian Journal of Psychiatry, 58(7), 376-385.
Foster, N. E., Anema, J. R., Cherkin, D., Chou, R., Cohen, S. P., Gross, D. P., ... & Turner, J. A.
(2018). Prevention and treatment of low back pain: evidence, challenges, and promising
directions. The Lancet, 391(10137), 2368-2383.
Gjestland, K., Bø, K., Owe, K. M., & Eberhard-Gran, M. (2013). Do pregnant women follow
exercise guidelines? Prevalence data among 3482 women, and prediction of low-back
pain, pelvic girdle pain and depression. British journal of sports medicine, 47(8), 515-
520.
Hartvigsen, J., Hancock, M. J., Kongsted, A., Louw, Q., Ferreira, M. L., Genevay, S., ... &
Smeets, R. J. (2018). What low back pain is and why we need to pay attention. The
Lancet, 391(10137), 2356-2367.

10INTEGRATED CASE STUDY MANAGEMENT
Jeong, U. C., Sim, J. H., Kim, C. Y., Hwang-Bo, G., & Nam, C. W. (2015). The effects of
gluteus muscle strengthening exercise and lumbar stabilization exercise on lumbar
muscle strength and balance in chronic low back pain patients. Journal of physical
therapy science, 27(12), 3813-3816.
Moon, H. J., Choi, K. H., Kim, D. H., Kim, H. J., Cho, Y. K., Lee, K. H., ... & Choi, Y. J.
(2013). Effect of lumbar stabilization and dynamic lumbar strengthening exercises in
patients with chronic low back pain. Annals of rehabilitation medicine, 37(1), 110.
Parry, G. J., Carson-Stevens, A., Luff, D. F., McPherson, M. E., & Goldmann, D. A. (2013).
Recommendations for evaluation of health care improvement initiatives. Academic
pediatrics, 13(6), S23-S30.
Richards, D. A., Ekers, D., McMillan, D., Taylor, R. S., Byford, S., Warren, F. C., ... &
O'Mahen, H. (2016). Cost and Outcome of Behavioural Activation versus Cognitive
Behavioural Therapy for Depression (COBRA): a randomised, controlled, non-inferiority
trial. The Lancet, 388(10047), 871-880.