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Physical Therapy for the client Pre/Post-Bariatric Surgery
April 6, 2010
Tamara L. Burlis, PT, DPT, CCSNot to be copied without permission of the speaker
Physical Therapy for the Client Pre/Post-Bariatric
Surgery
Tamara L. Burlis, PT, DPT, CCSWashington University Program in
Physical TherapyApril 6, 2010
Overall Goal
l Physical Therapists to become agents of change helping to prevent and remedy the obesity epidemic
l The development of overweight in normal weight individuals
l The progression of obesity in those who are already overweight
l Weight regain in those who have lost weight
l Further worsening of an obesity-related condition
2
Physical Therapy for the client Pre/Post-Bariatric Surgery
April 6, 2010
Tamara L. Burlis, PT, DPT, CCSNot to be copied without permission of the speaker
Objectives
l Understand the prevalence & implications for health & function;
l Discuss bariatric surgery and potential complications effecting the musculoskeletal system;
l Design appropriate screening, examination, and exercise interventions pre and post bariatric surgery;
l Identify mobility impairments, functional limitations and disabilities and methods to address interventions;
l Create strategies an educational materials to supplement a group exercise intervention and promote long term adherence to physically active lifestyles.
3
What is Obesity?
l Excessive accumulation of adipose tissue to an extent that health is impaired; BMI > 30 kg/m2
l Imbalance between caloric input & energy output Output
4
Physical Therapy for the client Pre/Post-Bariatric Surgery
April 6, 2010
Tamara L. Burlis, PT, DPT, CCSNot to be copied without permission of the speaker
Contributing Factors
l Contributing Factors• behavioral• environmental• physiological• social• cultural
l Examples• sedentary lifestyle• consumption of
energy dense food• family/social
gatherings surround food
• women more obese & less active than men
5
Health Comorbidities: Adults
l Cardiovascular disease
• HTN• Dyslipidemia
l Diabetes mellitusl Obstructive sleep
apneal Osteoarthritisl Asthmal Infertility
l Gallbladder diseasel Liver diseasel Metabolic syndromel Cerebrovascular
accidentsl Venous Stasisl GERDl Incontinencel Depression
6
Physical Therapy for the client Pre/Post-Bariatric Surgery
April 6, 2010
Tamara L. Burlis, PT, DPT, CCSNot to be copied without permission of the speaker
Functional Impairments/ Consequences
l Painl Dyspneal Strength deficitsl ROM deficitsl Balance deficitsl Coordination deficitsl Postural Aberrationsl Vital sign abnormalitiesl Decreased Aerobic
capacity
l Risk of fallingl Limited endurancel Compromised hygienel Dependence in
• bed mobility• transfers• gait• stairs• ADL’s
7
Patient Examination: Health History
l Health History• surgeries• orthopedic problems
• Prior treatment for obesity• diet, exercise, surgery, behavioral counseling, etc.• current adaptive equipment
• Current comorbidities• Current treatment regimens
• Medications• Diet• Activity level 8
Physical Therapy for the client Pre/Post-Bariatric Surgery
April 6, 2010
Tamara L. Burlis, PT, DPT, CCSNot to be copied without permission of the speaker
Patient Examination: Home Environment
l Self-Care Ability/Functional Limitationsl toileting, grooming, housework, bed mobility,
transfers, gait, work limitations, etc.l Home set-upl shower/tub, toilet/commode, bed, current
equipmentl stairs (in & outside)ldistances in home
l Help available/support systeml Occupation
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Patient Examination: System’s Review
l Organ System Checklist• General health• Cardiovascular • Pulmonary• Endocrine
l Vital Signs• HR, BP, SpO2, RR
10
Physical Therapy for the client Pre/Post-Bariatric Surgery
April 6, 2010
Tamara L. Burlis, PT, DPT, CCSNot to be copied without permission of the speaker
Patient Examination: Exercise Intentions & Expectations
l Physical activity & attitude questionnaire
l Activity History• activity regularity?• RPE of activity?• perceived fitness level?• willingness to routinely exercise?• support?• expectations?
11
Patient Examination: Objective Assessment
l BMI, Waist circumferencel Flexibility and ROM
• Note ROM limitations due to excessive tissue
l Muscle strength and endurancel Posturel Pain
• Individual joint assessments as needed
l Exercise capacity assessment• Maximal or sub-maximal**
12
Physical Therapy for the client Pre/Post-Bariatric Surgery
April 6, 2010
Tamara L. Burlis, PT, DPT, CCSNot to be copied without permission of the speaker
Types of Exercise Tests: Mode
lTreadmill/6MWlAdvantages: treadmill uses a familiar mode of
exercise (walking) and uses large muscle mass resulting in less localized fatiguelDisadvantages: space, expensive equipment
lBicyclelAdvantages: less LE joint stresslDisadvantages: local muscle fatigue
lStepslAdvantages: shorter testslDisadvantages: subject must maintain a steady pace
(metronome) and local muscle fatigue13
Patient Examination: Visual Inspection
l Body Type• Android vs Gynoid• Apple vs Pear
l Skin• discoloration• presence of lymphaedema• symmetry of extremities• atrophy• induration• wounds/ulcers
• presence of infection
14
Physical Therapy for the client Pre/Post-Bariatric Surgery
April 6, 2010
Tamara L. Burlis, PT, DPT, CCSNot to be copied without permission of the speaker
Postural Alignment Examples
15
Patient Examination: Functional Tests & Measures
l Transfersl Sit to Standl Floor to Standl Gaitl Stair Climbing l Balance
l Penny Retrievall Timed “UP &
GO”l Functional
Reach
16
Physical Therapy for the client Pre/Post-Bariatric Surgery
April 6, 2010
Tamara L. Burlis, PT, DPT, CCSNot to be copied without permission of the speaker
Patient Examination: General Transfers
l In and out of bedl Up and down from the chair, toilet
and/or floorl In and out of the car
• view or have patient verbally describe
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Patient Examination: Sit to Stand
l Timed test• Repeat sit to stand 5 times
• use 18”, 16”, 14” chair• Document use of UE’s, pain,
time, RPE & vital signs
18
Physical Therapy for the client Pre/Post-Bariatric Surgery
April 6, 2010
Tamara L. Burlis, PT, DPT, CCSNot to be copied without permission of the speaker
Patient Examination: Stair Climb
l timed one flightl ability to complete 4 flights
• document use of railings, • assistive device, method • (i.e. foot over foot), rests, etc..
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Testing Balance
n Narrow Baseqeyes open 10 sec.qeyes closed 10 sec.
n Rombergqeyes open 10 sec.qeyes closed 10 sec.
n Single Limb Stanceq30 seconds
20
Physical Therapy for the client Pre/Post-Bariatric Surgery
April 6, 2010
Tamara L. Burlis, PT, DPT, CCSNot to be copied without permission of the speaker
Patient Examination: Sensation
l Presence of Neuropathy• Light touch/pressure loss?• Pain?• Hypersensitivity?• Does loss affect function?
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Egress Test*
l Test 1: 3 reps of sit to standl Test 2: 3 steps of marching in placel Test 3: Advance step and return each footl If during any part of the Egress test, the
patient demonstrates difficulty or need for physical assistance beyond cues and/or guarding techniques, that patient is indicated for mechanical conveyance
* Michael Dionne, Choice Physical Therapy, Gainsville, GA22
Physical Therapy for the client Pre/Post-Bariatric Surgery
April 6, 2010
Tamara L. Burlis, PT, DPT, CCSNot to be copied without permission of the speaker
Patient Evaluation
l What are your clinical judgments(s) based on the data gathered during the patient/client examination?
• impairments• functional limitations• disabilities• movement diagnosis• health/safety concerns for activity• equipment needed to increase function or
limit disability23
Prognosis
l To achieve goals regarding:• Fitness level• impairments• function• weight loss• adherence to Physical Therapy HEP
l Will be affected by intention and readiness to change
24
Physical Therapy for the client Pre/Post-Bariatric Surgery
April 6, 2010
Tamara L. Burlis, PT, DPT, CCSNot to be copied without permission of the speaker
Why Physical Therapy in Managing Obesity
l Carefully Prescribed Exercise Counseling• Encourage sufficient physical activity to increase energy
expenditure, reduce fat storage and adjust energy balance to create a caloric deficit
• Monitor safety during performance of physical activity (i.e. cardiovascular and musculoskeletal)
• Reduce functional impairments and disablement
Energy Expenditure
Energy intake
25
The Acute Care Environment
l Mobilize the patient to preventbedrest complications & promote independence
l Prevention of injuries to patient & healthcare workers
l Address equipment Needs
26
Physical Therapy for the client Pre/Post-Bariatric Surgery
April 6, 2010
Tamara L. Burlis, PT, DPT, CCSNot to be copied without permission of the speaker
Transfer Techniques
l Continue with what the patient currently is doing
l Supine to long sitting to edge of bed
l Roll sidelying, push up with UE’s• (log or non-log rolling
techniques)l Roll prone, turn and push
up once LE’s reach floor
27
Transfer Assist
l Patient placementl Hand placementl Gait belt placement
• under pannus in abdominal fold• under axilla (especially if surgical incision)
l “Sling” techniquel Pillow use for kneel Blocking strategy
28
Physical Therapy for the client Pre/Post-Bariatric Surgery
April 6, 2010
Tamara L. Burlis, PT, DPT, CCSNot to be copied without permission of the speaker
Hand Placement for Transfers
Initial position
Final position
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Patient Examples
30
Physical Therapy for the client Pre/Post-Bariatric Surgery
April 6, 2010
Tamara L. Burlis, PT, DPT, CCSNot to be copied without permission of the speaker
Alternate Hand Placement
31
Knee Blocking Position
32
Physical Therapy for the client Pre/Post-Bariatric Surgery
April 6, 2010
Tamara L. Burlis, PT, DPT, CCSNot to be copied without permission of the speaker
Use of “Sling” to Assist with Transfers
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Front Therapist Position for use with “Sling”
34
Physical Therapy for the client Pre/Post-Bariatric Surgery
April 6, 2010
Tamara L. Burlis, PT, DPT, CCSNot to be copied without permission of the speaker
Acute Care Therapy Scheduling
lManpower issueslEquipment issuesl1 hour vs. 30 minute
sessions
35
Bariatric Equipment
l Plastic boardsl Hover matl Air Pall Bed sling liftl Overhead A-frame liftl Wheelchairs
• reclining vs. standard• wide
l Bariatric • walkers• beds• tilt table• bath bench • shower chair• commode• scales
36
Physical Therapy for the client Pre/Post-Bariatric Surgery
April 6, 2010
Tamara L. Burlis, PT, DPT, CCSNot to be copied without permission of the speaker
Bariatric Equipment: Beds and Chairs
37
Transfer & Gait Equipment
38
Physical Therapy for the client Pre/Post-Bariatric Surgery
April 6, 2010
Tamara L. Burlis, PT, DPT, CCSNot to be copied without permission of the speaker
Bariatric Equipment: Wheelchair/Scooters
39
Bed/Stretcher/Chairs
MC-600 StretchairMagnum II
40
Physical Therapy for the client Pre/Post-Bariatric Surgery
April 6, 2010
Tamara L. Burlis, PT, DPT, CCSNot to be copied without permission of the speaker
Bariatric Equipment:
AirPal or Hovermat
41
Gait Techniques
l Control of patientl Use of assistive devicel Do not block natural/adopted
patient movement• excessive lateral sway
42
Physical Therapy for the client Pre/Post-Bariatric Surgery
April 6, 2010
Tamara L. Burlis, PT, DPT, CCSNot to be copied without permission of the speaker
Prevention of Injuries
l Assess risk to patient and staff• higher the amount of physical assist needed the
greater the risk• consider use of mechanical assist devices
• Airpal, Hover Matt, Hoyer lift
• Utilize safety equipment and techniques• gait belts• manual hand placement• use of others e.g., Egress Test
l Proper training/Education of all involved (caregivers and patient)
43
Identification of RiskHow? & Who?
l High Risk Screening Program & subsequent pathway management for patients who are obese
l Implemented in hospital, SNF, and/or Nursing home to identify patients who are at high risk• Nursing or Therapy Services identify
• increased patient BMI• prolonged history of bedrest
44
Physical Therapy for the client Pre/Post-Bariatric Surgery
April 6, 2010
Tamara L. Burlis, PT, DPT, CCSNot to be copied without permission of the speaker
Additional Risk Factors & Useful Screening Information
• inability to lift extremities or head and trunk against gravity inability to roll, scoot, lift self in bed
• inability to physiologically tolerate position changes• orthostatic hypotension
• increased pain• extreme anxiety or fear of movement
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BARIATRIC GUIDELINES or PROCEDURE
l Identify patients at risk for injuryl PT evaluations
• assess mobility• assess functional status• recommend transfers
l Obtain equipment for safe patient management
l Discharge planning46
Physical Therapy for the client Pre/Post-Bariatric Surgery
April 6, 2010
Tamara L. Burlis, PT, DPT, CCSNot to be copied without permission of the speaker
Facility Actions to Maximize Patient Independence
l Comprehensive team approachl Staff trainingl Equipment prescription and
obtainment• rent/patient• facility purchase
47
Consequences of Facilities Unprepared for the Bariatric
Patient
l Patient withdrawal from interaction with staff• anxiety• fear• depressed• misplaced anger on staff
l Staff fear self-injuryl Staff fear injury to patientl Staff unintentionally avoid patient mobilizationl Prolonged discharge planning
48
Physical Therapy for the client Pre/Post-Bariatric Surgery
April 6, 2010
Tamara L. Burlis, PT, DPT, CCSNot to be copied without permission of the speaker
Exercise Prescription for All Environments
InpatientAcute Care
RehabilitationExtended Care Facilities
Outpatient
Exercise Prescription
l Intensity?l Low to moderate, my goal is RPE 13-15
l Duration?l 30-60 minutes /day, frequently use interval training to
begin
l Frequency?l Daily (somewhat dependent on duration and intensity)
l Mode?l Determine with client, likes and musculoskeletal concerns
l Consider Purpose and readiness50
Physical Therapy for the client Pre/Post-Bariatric Surgery
April 6, 2010
Tamara L. Burlis, PT, DPT, CCSNot to be copied without permission of the speaker
Factors to Consider in Prescribing Intensity
n Level of fitnessn Medicationsn Risk of cardiovascular and/or
orthopedic injuries n Likelihood of adherence/compliancen Preferencesn Program objectives
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Intensity Equivalents to RPE
52
Physical Therapy for the client Pre/Post-Bariatric Surgery
April 6, 2010
Tamara L. Burlis, PT, DPT, CCSNot to be copied without permission of the speaker
Example Prescription for Group Exercise Program
n 60 minute class sessionn 15 min. Balance/Controln 15 min. Strengtheningn 20 min. Endurancen 10 min. Flexibility
n All modified by:n Group compositionn Comorbidities, especially painn Participant preferencen Instructor Characteristics
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Lymphedema Management
l Refer to therapist trained inlymphedema care• use of compression garments• use of massage• use of ROM exercise
54
Physical Therapy for the client Pre/Post-Bariatric Surgery
April 6, 2010
Tamara L. Burlis, PT, DPT, CCSNot to be copied without permission of the speaker
The Surgical Patient: “Brad”
l 52 y/o, BMI 62.8 kg/m2
l Co-morbidities: Type II Diabetes, SAS, HTN, PVD, Depression, Joint pain, DVT
l Marital Status: Singlel Occupation: Sedentary, desk work for
the US government
55
Subjective Findings1
l Previous attempted management of his obesity: Commercial Programs, Pharmacological Therapy, Counseling, Independent and Group exercise
l All functional activities were becoming more difficult, he fatigued quickly, becoming short of breath with minimal exertion
l Used a cane for ambulation and had one flight of stairs in his home
l Participated in a low intensity water aerobic class one time/week when he was not overly fatigued.
56
Physical Therapy for the client Pre/Post-Bariatric Surgery
April 6, 2010
Tamara L. Burlis, PT, DPT, CCSNot to be copied without permission of the speaker
Subjective Findings2
l Right knee pain - 8/10
l Low back pain - 5/10
l Pain was worse with weight bearing activities and he was unable to stand or walk for long periods of time
l Goals were to improve his “strength, endurance and overall performance with functional activities”
57
0102030405060708090
100
PF
Role
-P
Pai
n
GH
Vit
alit
y SF
Role
-E MH
Pre-OPAge Matched
SF-36 Scores by Domain* and Male Age Matched
*PF=Physical Functioning, Role-P=Role Physical, Pain=Bodily Pain, GH=General Health,Vitality=Vitality, SF=Social Functioning, Role-E=Role Emotional, MH=Mental Health
58
Physical Therapy for the client Pre/Post-Bariatric Surgery
April 6, 2010
Tamara L. Burlis, PT, DPT, CCSNot to be copied without permission of the speaker
Objective Examination
l Appearance:• Centralized (Android)
obesity pattern• Dermatitis (Eczema)• Sway Back posture• Knee genu valgus• Ankle pronation• Forward Head• UE MR• Shoulder asymmetry
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Motor and Sensory Function
l Sensation: diminished to light touch -distalLE’s
l ROM: limited (B) hip and knee flexion due to excessive tissue accumulation
l MMT: deficits noted in shoulder flexion/extension, abdominals, LE muscle groups• proximal> distal
60
Physical Therapy for the client Pre/Post-Bariatric Surgery
April 6, 2010
Tamara L. Burlis, PT, DPT, CCSNot to be copied without permission of the speaker
Functional Activities
l Bed Mobility/Transfers (I)/UE’s
l ADL’s Modified (I)/UE’s*
l Half Kneel to Stand (I)/UE’s
l Sit to Stand (I)/UE’s unable to complete
l Gait Modified (I)/cane
l * Long handled scrub brush and hand held shower61
Postural Control
l Sitting: Able to maintain upright posture with maximal perturbations
l Standing:• Narrow Base
• eyes open 10 seconds• eyes closed 10 seconds
• Tandem Stance• eyes open 8.2 seconds• eyes closed Unable
• Single Limb Stance <2 seconds
62
Physical Therapy for the client Pre/Post-Bariatric Surgery
April 6, 2010
Tamara L. Burlis, PT, DPT, CCSNot to be copied without permission of the speaker
Endurance: 6 Minute Walk
l Patient completed 805 feet (2 MET) with one stop
l Vital Signs• HR: 92 bpm 140 108• BP: 142/90 mmHg 170/100 160/96• Rhythm: regular• RPE: 15
l Patient complaints: SOB, LBP, LE knee and ankle painl Noted: (B) gluteus medius limp
l Response Inc. HR and BP response for workload63
Primary Intervention
l Graduated exercise program*• Duration:
• 5-10’ activity/exercise• Frequency:
• 2-3 times/day• Intensity:light to moderate
• 50-69% of age adjusted HR (84-118 bpm)
• Increase each session time by 2-4’/week• Goal: 15-20’ sessions on most days of the week prior to
bariatric surgery
l * New CDC/ACSM guidelines64
Physical Therapy for the client Pre/Post-Bariatric Surgery
April 6, 2010
Tamara L. Burlis, PT, DPT, CCSNot to be copied without permission of the speaker
Initial Intervention
l Address musculoskeletal painlmay require additional
visitsl Exercise programl strengthlROMlendurancelbalancelcoordination
l Modes:lgroup Exercise l individual
appointmentslhome exercise
l Land &/or Waterl Use of journall Follow-up visits
65
Additional Initial Intervention
l Education for Post-Operative Mobility• log rolling• cough pillow• bed mobility• monitoring HR, RPE• diaphragmatic breathing/IS• posture • ambulation
l Identify bariatric equipment needs66
Physical Therapy for the client Pre/Post-Bariatric Surgery
April 6, 2010
Tamara L. Burlis, PT, DPT, CCSNot to be copied without permission of the speaker
Why Physical Therapy in Managing Obesity: Surgical Implications
l Minimize potential post-operative riskslpneumonialdeep vein thrombosis ---> pulmonary
emboluslpressure ulcer developmentldeconditioning effects of bedrest
l Avoid potential loss of muscle mass during rapid weight loss
67
Post-Surgical Inpatient Care Transitioning into Outpatient
l Evaluation to determine functional ability
• bed mobility• transfers• ambulation• self care• endurance• coughing and
breathing pattern• depth• effectiveness of
cough
l Intervention to facilitate and progress activity
• therapeutic ex.• deep breathing ex.• coughing ex.
l HEP: exercise prescription• Intensity, duration, frequency
l Note: no lifting > 10 lbs for 6 weeks, no val salvamaneuvers
68
Physical Therapy for the client Pre/Post-Bariatric Surgery
April 6, 2010
Tamara L. Burlis, PT, DPT, CCSNot to be copied without permission of the speaker
Surgical Candidate: Outpatient Care
l Frequencyl Ideally follow patients through routine clinic
visits or through phone conversations and PRN visits to progress activity, add resistive training at 6 weeks and manage pain syndromes
l GoalslResume and expand activitylPromote correct movementlLifestyle modification
69
Management of Obesity
Alternative Interventions
Physical Therapy for the client Pre/Post-Bariatric Surgery
April 6, 2010
Tamara L. Burlis, PT, DPT, CCSNot to be copied without permission of the speaker
Weight Loss Options?
n Conventional Methodsn Dietn Exercisen Behavior Modificationn Anti-Obesity Drugs
n Surgical Therapyn Weight Loss Surgery
• 95% to 98% failure rates of sustained weight loss in obese population at 5 years
•100% failure of sustained weight loss for the morbidly obese population
• 50% success rate at 16 years Eliosoff 1997
Dietel 1999ASBS 2000
71
Movement: Promoting Physical Activity and Exercise
n A primary care obligationqCongruent with goals of Healthy People
2010 to increase the activity level of adults and adolescents who exercise regularly
n A physical therapy opportunityqConsistent with scope of work in
rehabilitation and prevention outlined in the Guide to Physical Therapist Practice (2001)
72
Physical Therapy for the client Pre/Post-Bariatric Surgery
April 6, 2010
Tamara L. Burlis, PT, DPT, CCSNot to be copied without permission of the speaker
The Evidence for Movement
n Effective in weight control if incorporated into lifestyle
n Compromised by attitudes toward feasibility of exercise and physical activity
n Complicated by challenges in measurementn Affected by individual differences in tissue
distribution and physiologyn Influenced by short follow-up and recidivism
ratesn Compromised by difficulty quantifying exertion
during recreational activities73
Behavioral Management Strategies
n Use of Contractsn Goal establishmentn Reward systemn Create situations where
success can be achieved• small reachable and measurable goals
74
Physical Therapy for the client Pre/Post-Bariatric Surgery
April 6, 2010
Tamara L. Burlis, PT, DPT, CCSNot to be copied without permission of the speaker
Who Qualifies for Gastric Bypass?
n 1991 NIH Consensus Development Conference Criteria:
n 1) 100lbs. Over Ideal WeightnBMI > 40 or > 35 w/co-morbidities
n 2) Voluntary Weight Loss Failedn 3) A patient that is medically and
psychologically stable, cooperative, able to tolerate surgery, and is well informed.
75
Who Is a Surgical Candidate?
n Meets NIH criterian No endocrine cause
of obesityn Acceptable operative
riskn Understands surgery
and risks n Absence of drug or
alcohol problem n Dedicated to life-
style change and follow-up
n No uncontrolled psychological conditions Consensus after bariatric team evaluation:q psychologist/behavioristq surgeonq dieticianq physical therapist
76
Physical Therapy for the client Pre/Post-Bariatric Surgery
April 6, 2010
Tamara L. Burlis, PT, DPT, CCSNot to be copied without permission of the speaker
Why Surgery?
n Improvement in Health Conditionsn Sustainable Weight Lossn Reduction of Life-Threatening Risk Factorsn Improving Activities of Daily Livingn Improvement of Self-Esteemn Achieving One’s Own Perception of
“Normal”n Multiple weight loss attempts have failed
77
Possible Complications
n Gastric Leaksn Bleedingn Development of a
Fistulan Obstructionn Pulmonary
Complicationsn Infectionn Hernias
n Stricturesn Stomal Ulcersn Ventral Hernian Anemia & B12
Deficiencyn Gallstonesn Wound Herniationn Bowel Obstructionn Death
78
Physical Therapy for the client Pre/Post-Bariatric Surgery
April 6, 2010
Tamara L. Burlis, PT, DPT, CCSNot to be copied without permission of the speaker
Bariatric Surgery: Options
n Malabsorption qbiliopancreatic diversion ± duodenal switchqJejunoileal bypass (small intestine)
n Restrictionqvertical banded gastroplastyqadjustable gastric banding
n Hybrid of restriction andmalabsorptionqRoux-en-Y gastric bypass
qGastric Stimulators79
The Evidence for Surgery
n Risk of mortality is lower than controls (and generally occurs in first six months)
n Generally effective in losing > 100 lbs. of excess weight
n > 80% of patients maintain a 50% excess weight loss at 16 years
n Carries risk of nutritional deficiencies and potential for conditions as berri berri
n Mortality rates are generally < 2%80
Physical Therapy for the client Pre/Post-Bariatric Surgery
April 6, 2010
Tamara L. Burlis, PT, DPT, CCSNot to be copied without permission of the speaker
Medical Co-Morbidities Resolved
Type 2 Diabetes95%
Hypertension92%
Cardiac Function95%
improvement
Osteoarthritis82%
Sleep Apnea75%
GERD98%
Stress Incontinence87%
Hypercholesterolemia97%
Wittgrove AC,Clark GW. Laparoscopic Gastric bypass roux-n-y-500 patients. Obese Surg 2000. And others.
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Bariatric Surgery Incisions
Laparoscopic Open82
Physical Therapy for the client Pre/Post-Bariatric Surgery
April 6, 2010
Tamara L. Burlis, PT, DPT, CCSNot to be copied without permission of the speaker
According to the NIH...
n “Surgery is the most effective option in achieving sustained weight loss in the morbidly obese patient population.”however... Surgery alone will not guarantee success. Work and long-term commitment are required by patients
83
