732 - Overcoming Challenges in Inpatient Rehabilitation for Bariatric Patients: A Case Study

Case Diagnosis: Deconditioning in the setting of class III obesity

Case Description: A 58-year-old male with class III obesity (BMI 57) and deconditioning due to prolonged hospitalization was admitted for inpatient rehabilitation. His clinical picture was complicated by congestive heart failure, atrial fibrillation and knee osteoarthritis. Medical stability was prioritized by optimizing cardiovascular status. His knee pain was addressed using a multimodal approach including intra-articular corticosteroid injections. He was prescribed physical, occupational and recreation therapies. The focus of treatment was improving mobility, self-care and endurance. Aquatic therapy was used to enhance these goals. During his 50-day admission, his total FIM score increased by 30 points from 67 to 97. However, several barriers delayed optimal care including initial unavailability of bariatric equipment.

Discussions: According to literature review, patients with obesity do not experience worse functional outcomes or increased length of stay compared to patients without obesity. The efficiency of care, however, may be affected by a variety of factors. Aquatic therapy, for example, may enhance the benefits of traditional therapy and maintenance of functional gains. Contrarily, environmental factors such as the availability of appropriate and properly functioning equipment can serve as barriers to providing safe, efficient care. Equipment to consider in the care for these patients include proper-fitting beds, assistive devices, lifts, and transportation vehicles.

Conclusions: The observed benefits of aquatic therapy in an inpatient rehabilitation program for patients with deconditioning and obesity should be further explored. For these patients, the quality and safety of care in the acute rehabilitation setting may be improved with a standardized admission process. Such protocols could include the use of a comprehensive admission checklist verifying a properly equipped physical environment and well-prepared nursing staff with training on optimal ergonomic patient handling. These efforts can help reduce sources of systemic bias in the delivery of healthcare to patients with obesity.