Rehabilitation for bariatric patients

Abstract

Morbidly obese patients can achieve functional improvement1 but they often experience increased post-acute rehabilitation length of stay due to the limitations of the healthcare system.2 This study aims to develop targeted interventions to optimise rehabilitation care delivery for bariatric patients. We reviewed the medical records of two inpatients at the rehabilitation ward in Sunshine Hospital, Victoria. The patients were morbidly obese (weight of 180 and 196 kg respectively) and had a few months of complicated acute hospital stay (10 and 12 weeks respectively). On admission to the rehabilitation ward, both patients required full nursing care and were non-ambulant. Factors related to the patients, staff and environment which posed challenges to the rehabilitation and discharge planning were recorded. Multiple factors account for the difficulties in rehabilitating bariatric patients. Morbidly obese patients tend to develop more frequent and severe medical complications during their subacute stay.3 It also takes longer for them to recover from the illnesses. Increased number of nursing staff is required to provide the appropriate care needs. Occupational health and safety issues are frequent, with multiple nursing staff having to take sick leave due to musculoskeletal injuries. A room with larger space and bariatric-specific equipment are essential for patient comfort, effective nursing care and physical therapies. Discharge planning process can be complex as extensive home modification and support are often required. Temporary discharge destination options need to be explored early on as bariatric patients take longer time to achieve functional improvement. Multiple factors contribute to challenges in bariatric rehabilitation. Prior to admitting morbidly obese patients into the rehabilitation ward, it is prudent to educate staff,4 involve the occupational health and safety department, and ensure the availability of the required equipment3 and room. To reduce the length of stay at the rehabilitation ward, the treating team needs to explore the available support options and assess home environment early on during admission. While increasing the number of nursing staff imposes a financial strain to the hospital, it will not only reduce the physical and psychological burden of the nursing team, but also allow the patient to have extra therapies. Close monitoring of the medical condition and provision of weight loss programme may potentially prevent hospital-related and obesity-related complications, and subsequently improve the patient’s functional gains during therapy sessions. Surmounting obstacles relating to rehabilitation of bariatric patients should commence at the earliest possible time and continue throughout the admission to optimise the outcome of the patients.