K. Hwa1, E. Kubat1, E. Hardin1, D. Eisenberg1 1Stanford School Of Medicine And Palo Alto VA HCS,Surgery,Palo Alto, CA, USA
Introduction: Musculoskeletal disease is common in the obese and veteran populations. We examined the impact of a dedicated physical therapist in a multidisciplinary bariatric clinic.
Methods: A prospective bariatric database was retrospectively reviewed. Bariatric patients were followed before and after surgery in a multidisciplinary clinic that included a physical therapist (PT). Patients had a PT-supervised six-minute walk test (6mwt) at each visit. The distance covered during the test was noted. Differences in means were compared using student's t-test.
Results: A PT followed 74 patients who underwent bariatric surgery. Their average preoperative body mass index (BMI) was 45.8 kg/m2, age 53 years, and 78% were male. Of these, 83.8% had preoperative complaints of musculoskeletal pain, 52.7% had a pre-existing diagnosis of degenerative disc disease or osteoarthritis of lower extremity joints. These patients underwent intensive follow-up by the PT before and after surgery, with interventions including instruction in joint-protective exercises, elastic band strengthening exercises, use of TENS units, chair exercises, and pool therapy. Patients underwent preoperative and postoperative 6-minute walk test (6mwt) to assess progress. At 12 months after bariatric surgery, the cohort of patients with a diagnosis of lower back or lower extremity joint disease receiving intensive physical therapy instruction had a significantly greater %EBMIL (62.8% vs. 49.7%, p=0.048) compared to the other patients who did not have a musculoskeletal diagnosis. There was also a greater increase in 6-mwt distance traveled, although this was not statistically significant (57.4% vs. 20.1%, p=0.212).
Conclusion:Lower back and lower extremity pain is common in veterans presenting for bariatric surgery. A majority of these patients have a prior diagnosis of degenerative joint or disc disease. Intensive preoperative and postoperative treatment by a PT results in superior weight loss and improved exercise tolerance.