Mobility and self-care outcomes in patients with a bariatric comorbidity during inpatient rehabilitation

Objective: First, we describe the characteristics and functional outcomes of obese and bariatric patients in an inpatient rehabilitation facility (IRF). Second, we assessed differences in functional outcomes for bariatric, obese, and standard weight body mass index (BMI) groups. Third, we explored whether these characteristics differ between time periods and diagnostic groups.Design: A retrospective study comparing electronic medical record data collected in 2016 and 2018, using a repeated cross-sectional cohort design.Setting: IRF.Participants: Individuals >= 18 years of age diagnosed with brain injury, medical complexity, general neurology, orthopedic, spinal cord injury (SCI), and stroke. Participants grouped as standard (BMI <30 kg/m(2)), obese (BMI 30-39 kg/m(2)), and bariatric (BMI >= 40 kg/m(2)) weights. (N = 2015 in 2016, N = 2768 in 2018.)Interventions: Patients received standard inpatient rehabilitation. In 2018, clinicians had access to new weight-appropriate equipment.Main Outcome Measures: Discharge destination; length of stay (LOS) by BMI group and medical diagnoses; item-specific functional index measure (FIM) change scores.Results: Sixty-four percent to 67% of all BMI groups achieved a home discharge. The bariatric BMI group had a longer LOS (21 days) than the standard or obese groups. There was a significant interaction in a linear regression analysis between diagnosis and LOS, where LOS was longer in medically complex patients with bariatric BMI (19.3 days compared to 16.1 days) but shorter in bariatric patients with SCI (20.6 days) compared to standard weight patients (26.2 days). In 2018, the bariatric BMI group had greater average FIM change scores for bathing, lower body dressing, toilet transfers, and bed transfers.Conclusions: Patient BMI is associated with LOS in the IRF, although affected by diagnosis. Patients with higher BMIs can make changes in specific individual motor FIM items. For patients with bariatric BMIs, FIM change scores were higher in 2018, possibly due to the use of equipment and facilities designed for higher weight capacities.