Physical Therapy and Obesity
This month I was actually able to stay current when I read my PT Journal
. I found an interesting article. The researchers looked at the approaches and attitudes of PTs toward the obese. They questioned a random sample of currently practicing therapists using mailer surveys. The results suggested that PTs have neutral attitudes toward people who are obese. (Sack, Radler, Mairella, Touger-Decker, Khan, 2009) In addition, many of the PTs (20.4 percent) who responded identified the need to lose weight, but did not feel qualified to provide that intervention. (Sack, Radler, Mairella, Touger-Decker, Khan, 2009) Those results didn't surprise me.
Obesity is defined as an increase in body weight beyond the limitations of skeletal and physical reinforcement. Morbid obesity is defined as excess body fat that has an adverse effect on health. (The Free Dictionary, 2009) There is a general consensus that the rate of obesity is continuing to climb in America. Obese patients are a common part of practice today. Research concerning PT and obesity is necessary to determine evidence for the best practices. In this case, though, I think the researchers asked the wrong question.
PTs are trained health care providers. They view obesity as just one of a multitude of possible co-morbidities. It would be expected that their opinion as a whole would be neutral. I think a more telling question would have been to ask how those PTs felt about treating obese and morbidly obese patients. I think the answers would have been somewhat different. It's already been established that obesity is associated with poorer outcomes and longer length of hospital stays. The same relationship is probably true between obesity and PT.
For example, an obese person s/p a total joint replacement is going to be at a disadvantage. The increased weight on the joint will increase pain. More muscle strength will be needed for the limb to move so the limb will require additional strengthening. The extra weight will cause fatigue more quickly. The overall therapy will take longer to get the same results. The added days will cause the insurance company to pay more. Progress in therapy will be slower.
The problem is more acute in an inpatient setting. Whenever I have an overweight or obese patient I know I'm going to have to work harder to mobilize that patient. I usually don't have help so I'm going to have to do it myself and my fatigue level will decrease. Two weeks ago I worked with a CVA patient who tipped the scales at 534 pounds. I had orders to mobilize her. With the assist of the CAN, I got her to the EOB. She had right-sided weakness and fell to the left. Even with my whole body weight sitting on the bed I couldn't keep her from falling over. I had to elevate the HOB as high as possible and have her lean on a bed rail. We never got beyond sitting EOB.
Let me be clear. I'm not complaining about that patient. Working with patients like that is part of the territory. What I am doing is using her as an example of the difference in treatment the extra weight made. I would be very interested in the opinions of PTs concerning the actual provision of care to an obese person. I would also be interested in knowing how many facilities have purchased bariatric equipment in adequate numbers. In my experience as soon as someone goes into the bariatric w/c you will need another one. The rest of the time the chair will sit and gather dust. I would also like to know if facilities have changed staffing patterns to accommodate the obese. Finally I would like to know how many therapists who work with obese patients are concerned about potentially injuring themselves while providing therapy. I worry about that all the time because I am a single income person. If I don't work, I'm out of luck so to speak.
The research in this article is a good start. It answers one question but asks dozens more. Clearly more research is needed on the topic. Maybe someone could survey obese patients about how they perceived therapy in addition to surveying therapists. I'm sure that would have interesting results. From the answers to these questions will come changes in practice patterns and educational offerings.
The Free Dictionary. (2009) Retrieved from http://medicaldictionary.thefreedictionary.com/morbid+obesity
Sack, S., Radler, D., Mairella, K., Touger-Decker, R,. Khan, H. (2009) Physical therapists' attitudes, knowledge and practice approaches regarding people who are obese. Physical Therapy, 89, 804-815.