Inpatient Rehabilitation Trends in the Morbidly Obese Population

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Inpatient Rehabilitation Trends in the Morbidly
Obese Population Paul Thananopavarn MD, Monica
Carrion-Jones MD, Ann Nunez MD, Stephanie Slayton
PT, Daniel Wong PhD Pitt County Memorial
Hospital/East Carolina University Brody School of
Medicine, Greenville, NC
Study Hypothesis Inpatient rehabilitation
patients with morbid obesity (BMI gt40) have lower
Functional Independent Measure (FIM) gains,
Longer Lengths of Stay (LOS), and less favorable
discharge destinations than patients without
morbid obesity. Design Retrospective chart
review. Setting The study was based at Pitt
County Memorial Hospital Regional Rehabilitation
Center, a tertiary care center in eastern North
Carolina. Participants All patients admitted
to acute rehabilitation center between January
2002 and November 2006 with morbid obesity as a
diagnosis code (278.01). This group was compared
to the entire population of patients admitted to
the same rehabilitation center without morbid
obesity as a diagnosis code. All rehab impairment
groups were examined, including orthopedic
diagnoses, stroke, traumatic brain injuries,
multiple trauma, amputations, spinal cord
injuries, cardiac and pulmonary
debility. Methods Medical records of patients
admitted to inpatient rehabilitation with a
morbid obesity diagnostic code of 728.01 (n383 /
Ave age56) were reviewed compared to medical
records of patients without a morbid obesity code
(n5384 / Ave age63). A simple t-test was used
to compare the two groups. Mean Outcome Measures
Admission FIM scores, discharge FIM scores,
length of stay (LOS), FIM gain, Length of Stay
Efficiency (FIM Gain divided by LOS). Results
The morbidly obese (MO) group had an Admit FIM
Score of 66.8 and a FIM Gain of 17.96. The
non-obese (control) population had an Admit FIM
Score 64.02 and a FIM Gain 17.90. The MO group
had an average LOS of 17 days and a LOS
Efficiency of 1.08. The control group had an
average LOS of 14 days and a LOS Efficiency of
1.25. Statistical analysis showed a significant
difference in LOS (p 0.025) but no significant
difference in FIM Gain. Discussion In this
retrospective cohort study, morbidly obese
patients had comparable admit FIMs and achieved
comparable FIM gains over a longer period of time
than non-obese patients. This is likely due to
the increase difficulty with FIMs requiring
mobility of the entire body. In subgroup FIM
analysis, morbidly obese rehab patients had lower
average admit scores in locomotion, transfers,
stairs, lower body dressing, toilet / tub
transfers, bathing and toileting. With the
exception of stairs and tub transfers, these
areas also showed higher average FIM gains in the
morbidly obese cohort. These FIM gains in
mobility contributed to a comparable rate of
discharges to home but requiring longer lengths
of stays. Morbid obesity is associated with many
other medical conditions such as diabetes, which
may have contributed to the higher rate of return
to acute hospitalization in the obese population.

Abstract Hypothesis To evaluate the hypothesis
that inpatient rehabilitation patients with
morbid obesity have lower Functional Independent
Measure (FIM) gains, Longer Lengths of Stay (
LOS), and less favorable discharge destinations
than patients without morbid obesity. Design
Retrospective chart review. Setting Regional
Rehabilitation Center in a Tertiary care center
in Eastern North Carolina. Participants Patients
admitted to acute rehabilitation center between
January 2002 and November 2006 with morbid
obesity as a diagnosis code (278.01). This group
was compared to the population of patients
admitted to the same rehabilitation center
without morbid obesity as a diagnosis
code. Methods All medical records of patients
admitted to inpatient rehabilitation with a
morbid obesity diagnostic code of 728.01 (n383)
were reviewed compared to medical records of
patients without a morbid obesity code (n5384).
A simple t-test was used to compare the two
groups. Mean Outcome Measures Admission FIM
scores, discharge FIM scores, length of stay
(LOS), FIM gain, Length of Stay Efficiency.
Results The morbidly obese (MO) group had an
Admit FIM Score of 66.8 and a FIM Gain of 17.96.
The non-obese (control) population had an Admit
FIM Score 64.02 and a FIM Gain 17.90. The MO
group had an average LOS of 17 days and a LOS
Efficiency of 1.08. The control group had an
average LOS of 14 days and a LOS Efficiency of
1.25. Statistical analysis showed a significant
difference in LOS (p 0.025) but no significant
difference in FIM Gain. Conclusion Morbidly
obese rehabilitation patients require a greater
length of stay to achieve FIM gains comparable to
that of the non-morbidly-obese population. The
morbidly obese rehab inpatients had a greater
rate of discharge to home, however, also had a
greater rate of return to acute hospitalization
as compared to the non-bariatric population.
Key Words Obesity, Morbid, Rehabilitation
Non-Obese Discharge Destination N5384
Morbidly Obese Dischage Destination N383

• Examples of equipment used in our rehabilitation
  center
• Barimaxx, KCI bariatric equipment, Arycare lift,
  Hoover mat and Stretch Bariatric chair (SIZEWise
  Rentals, L.L.C.)

Conclusion Morbidly obese rehabilitation
patients required a greater length of stay to
achieve FIM gains comparable to that of the
non-morbidly-obese population. Activities
requiring mobility of the entire body are of
particular difficulty for the obese patient, but
are also the areas of greatest potential gain.
The morbidly obese rehab inpatients had a
tendency to a greater rate of discharge to home,
however, also had a greater rate of return to
acute hospitalization as compared to the
non-bariatric population.
Barimaxx Bed (courtesy of KCI)
Bariatric Equipment (courtesy of KCI)
Arycare Lift (photo courtesy of AryCare)
Hoover Mat and Stretch Bariatric Chair (photo
courtesy of SIZEWise Rentals, L.L.C)