Which of the following may be a contraindication for initiating extremity joint mobilization in a patient with chronic pulmonary disease?

Long-term corticosteroid therapy may be a contraindication for initiating extremity joint mobilization in patients with chronic pulmonary disease due to the systemic effects of corticosteroids on the musculoskeletal and immune systems. Prolonged use of corticosteroids can result in adverse effects such as osteoporosis, muscle weakness, and compromised healing, which can increase the risk of fractures and may complicate joint mobilization efforts.

In patients receiving such therapy, there's a heightened concern for potential musculoskeletal complications, including weakened bones and increased vulnerability to injury during therapeutic interventions. Therefore, joint mobilization might need to be approached cautiously or avoided in these individuals to prevent exacerbating these risks.

Other options, while relevant to patient care, do not directly correlate to contraindications for joint mobilization in the same way. Reflex muscle guarding may actually indicate a protective mechanism and could be a sign to adjust techniques rather than a complete contraindication. Concurrent inhalation therapy is generally supportive of respiratory function and can facilitate better patient outcomes during mobilization. Functional chest wall immobility might suggest an increased need for mobilization to improve function, rather than being a reason to avoid it.