The efficacy of in-reach rehabilitation in morbidly obese post septic patients: Two retrospective case reports
Baheerathan Narayanan, Friedbert Kohler, Patrick Arulanandam
Aged Care and Rehabilitation, Concord Repatriation General Hospital, Sydney, Australia
Objective: To report the functional outcomes of two patients with morbid obesity (>â€‰250 kg) who received in-reach rehabilitation after hospitalization for sepsis in Sydney, Australia.
Case reports: A retrospective review of hospital charts was performed with the informed consent of both patients. Body mass index, demographics, length of stay, functional status at admission and discharge, medical comorbidities, social history, hospital course, equipment needs, therapy methods used, and discharge disposition were compared. Results: Both patients had a positive outcome. Func-tion improved in case 1, from requiring hoist transfers, to mobilizing 80 m with 2 assistants. The patient was transferred to a subacute rehabilitation facility, but did not make any gain in Functional Independence Measure. Function improved in case 2, from requiring 2 assistants to walk with a frame, to walking independently with a 4-wheeled walker. The patient was discharged home from the acute hospital, with a minimal Functional Independence Measure gain of 8. Both patients lost approximately 45 kg during acute hospitalization.
Conclusion: These case reports demonstrate that in-reach rehabilitation can play an important role in the functional recovery of morbidly obese patients hospitalized with severe sepsis. This report also highlights the need for preventive interventions to reduce avoidable acute hospital presentations and to prevent functional decline.
These 2 case reports demonstrate the role of a rehabilitation intervention in improving functional outcome in severely obese patients who have lost function after being admitted to hospital for a severe infection. Both patients weighed over 250 kg, and received rehabilitation after a severe infection. These cases demonstrate how in-reach rehabilitation, provided by a rehabilitation team, resulted in improved function, enabling one patient to be discharged directly home, and the other to be transferred to a dedicated rehabilitation facility. These cases illustrate the complexities and benefits of providing rehabilitation in the acute hospital setting for this patient group.
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