Obese achieve functional improvements after trauma rehab

Jul 10 2012

By MedWire Reporters

Obese patients participating in a rehabilitation program for orthopedic trauma can achieve meaningful functional independence before discharge, US research shows.

Even morbidly obese patients achieved improvements in independence with the rehabilitation program.

The results suggest that "obesity itself does not preclude referral or admission to inpatient rehabilitation," according to Heather Vincent (Orthopaedics and Sports Medicine Institute, Gainesville, Florida) and colleagues.

Obesity is not only a risk factor for trauma, but it also increases the risk for complications following elective orthopedic procedures. As a result, inpatient rehabilitation programs are designed to maximize physical function before discharge home after trauma surgery.

However, as Vincent and colleagues point out in the American Journal of Physical Medicine and Rehabilitation, healthcare providers often assume that obese and morbidly obese patients are not suitable for aggressive physical rehabilitation.

In a retrospective review of 294 consecutive patients admitted to an inpatient rehabilitation hospital, the researchers examined differences in functional outcomes among obese (n=111) and nonobese (n=183) patients. The main injury sites were the femur, knee, pelvis, and arm.

There was no significant difference in participation in the program, with both groups participating in more than 90% of the physical therapy sessions. Therapy intensity did not differ either, with obese and nonobese subjects completing more than five sessions per day.

Hospital length of stay for obese and nonobese subjects was 9.9 and 9.7 days, respectively. Readmissions for acute care did not differ between the two groups.

Using the functional independence measure (FIM) to assess physical function, the total and motor FIM rating was significantly lower in obese subjects at discharge compared with nonobese patients.

The changes in the total FIM rating from admission to discharge were 43% in the nonobese subjects and 32% in the obese group, a significant between-group difference. Similarly, the changes in the motor FIM rating from admission to discharge were also significantly different between nonobese and obese subjects, at 57% and 37%, respectively.

Overall, the percentage of patients who achieved "complete independence" or who required "supervision" only was not different in the obese and nonobese subjects for major functional and mobility tasks.

In addition, there was no between-group difference in the ability to climb stairs or travel specified distances by walking or wheelchair.

The researchers conclude that healthcare providers "can expect significant functional improvement after inpatient rehabilitation irrespective of BMI [body mass index]."

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