Hospital rehabilitation for patients with obesity: a scoping review

Abstract

Purpose: To explore the evidence on rehabilitation for hospitalized patients with obesity.

Methods: Medline, Embase, CENTRAL, CINAHL, and PubMed were searched from 1994 to May 2016. Grey literature was hand-searched. Two reviewers independently selected studies examining patients with obesity receiving hospital-based therapy for a physical impairment. One reviewer extracted the data and a second reviewer verified a random sample.

Results: Thirty-nine studies (two trials, 37 observational) were included. Patients underwent rehabilitation following orthopaedic surgery (n = 25), neurological conditions (n = 7), acute medical illnesses (n = 3), or various procedures (n = 4). Three studies investigated the effectiveness of a specific rehabilitation program in patients with obesity; however, two lacked a control group, precluding inferences of causal associations. Most studies compared functional outcomes across patients in different BMI categories (n = 33). There was much variability in the rehabilitation components, intensity, and providers used across the studies. The most frequent components were gait training and mobility (n = 17) and training in assistive devices (n = 12). Across the 50 outcomes measured, length of hospital stay (n = 24) and Functional Independence Measure (n = 15) were assessed most frequently.

Conclusions: Evidence to guide rehabilitation for patients with obesity is sparse and weak. Rigorous comparative studies with clearly defined interventions and consensus outcome measures are needed.

Implications for Rehabilitation

• Obesity rates have dramatically increased among patients requiring rehabilitation following joint arthroplasty, stroke, injury, or an acute medical event.

• There are currently no guidelines by which to define best practice for rehabilitating patients with obesity and comparative studies on rehabilitation programs are needed.

• Professional development focused on patient-centered rehabilitation and sensitivity training is known to promote quality care, reduce weight bias, and improve patient satisfaction.

• Access to and knowledge about equipment is necessary to promote patient and health care provider safety.

Keywords:

• Rehabilitation
• obesity
• bariatrics
• physical therapy
• occupational therapy
• scoping review

Acknowledgements

The authors are grateful to Ms. Robin Featherstone, MLIS, for assistance in designing and conducting the literature searches, and to Ms. Kristine Godziuk and Ms. Sophie Collins for assistance in screening studies and verifying data.

Disclosure statement

The authors report no conflicts of interest.

Funding

This work was supported by Alberta Innovates-Health Solutions (AIHS, 10.13039/501100000145) under a Partnership for Research and Innovation in the Health System (PRIHS) grant (grant number 201300733). JAJ held a Senior Health Scholar with AIHS.