1. The Walton Centre NHS Foundation Trust, Liverpool, UK.
Lifestyle conditions and need for dietetic input within the complex rehabilitation unit.
Laura Parsons (Specialist Dietitian) Dr. Ganesh Bavikatte (Neurorehabilitation Consultant)
The Walton Centre NHS Foundation Trust, Liverpool, UK.
Background
The Cheshire and Merseyside Rehabilitation network (CMRN) is a unique service and is considered to be a role model for the delivery of specialist rehabilitation. The Hub and Spoke model consists of level 1 (acute and hyper acute) level 2 (post acute) , slow stream and community rehab services. The network serves a population of about 3.3 million people from Cheshire, Merseyside, North Wales and the Isle of Man. The Complex rehabilitation unit is a 30 bedded unit based in the Sid Watkins building at the Walton Centre and delivers both level 1 and level 2 care.
A study by Duraski et al (2014) highlights a number of nutritional challenges which are often experienced within the rehabilitation setting, including weight gain. A study in weight gain post spinal cord injury (SCI) found individuals with SCI will initially lose weight. However, some individuals may continue to lose weight and consequently become underweight, while others may gain extreme amounts of weight following rehabilitation (Powel et al 2016).It is felt that patients with reduced mobility regardless of the initial injury would be at similar risk, due to the comparative nature of the recovery process. The effects of weight gain during the rehabilitation phase are unknown however a study by Kalichman et al (2016) stated the following, chronic hemiparetic patients with a higher BMI were less likely to demonstrate gains in motor impairment or improvement on their up and go performance, irrespective of treatment intervention. Severely obese patients improved physically but at a lower efficiency and greater cost. Overweight or obese was associated with diminished motor FIM outcomes at discharge from rehabilitation. A further study by Brown et al (2006) state that obese patients suffer more complications and higher mortality than lean patients after TBI, a previous study by Brown et al (2005) states obese patients suffer more complications, require longer stays in the hospital, more days of mechanical ventilation, and obesity is independently associated with mortality. “Evidence exists to support weight loss interventions situated in rehabilitation programs for patients with cardiovascular disease, spinal cord injury, osteoarthritis, and severe mental illness. Targeted strategies are needed to meet the physical and cognitive needs of these populations and to increase adherence to physical exercise and healthy eating. Further research is needed to determine the feasibility and effectiveness of using existing obesity assessment and weight loss interventions for use with obese patients in rehabilitation programs.” (Forhan 2014)
The benefits of weight loss are discussed by Villareal et al (2011) who state that weight loss especially that achieved through diet and exercise can improve physical function and by Bouchonville et al (2014) who states “lifestyle interventions associated with weight loss improve insulin sensitivity and other cardiometabolic risk factors”.
Objectives
To review the incidence of lifestyle conditions, overweight and obesity, diabetes (DM) and cardiovascular disease (CVD)
Method
Data was collected from medical records for all admissions to the complex rehabilitation unit (CRU) from January 2014 until December Data collected included if patient had a diagnosis of DM, CVD and BMI, length of stay, age, gender and reason for admission.
Patient group
66 Patients in total
Average length of stay 112 days range 25–272 days (n=63
Diabetes results (n=66)
15% of patients had a diagnosis of diabetes.
Compared to 4.6% of the UK population. Diabetes UK (2013)
Length of stay was increased for those with diabetes (147 days with DM vs 120 with no DM diagnosis.
Results overweight and obese (n=65)
43% of patients were classified as overweight (BMI kg/m²)
20%of patients were classified as obese (BMI ≥30kg/m²)
Total population overweight and obese 63%.
In England 61.7% of people are either overweight or obese. The Health and Social Care Information Centre (2013)
Admission
Discharge
36% of patients in the obese and over weight category.
45% of patients in the obese and overweight category.
13% considered obese.
19% considered obese.
35% in the healthy weight category.
36% in the healthy weight category.
29% underweight.
19% underweight.
BMI admission vs. discharge
Discussion
Patients admitted to the CRU suffer from a variety of lifestyle conditions which can have an affect on the outcome of their rehabilitation. Highlighting the need for specialist dietetic input in the areas of weight management and diabetes care.