Between 1980 and 2000, obesity rates doubled in the United States, according to Kevin Huffman, MD, of American Bariatric Consultants in Vermilion, Ohio. During that same time period, the number of obese adults tripled and the number of morbid obese adults quadrupled. Huffman is a board-certified bariatric physician with more than 20 years of clinical experience in obesity management. He is also founder and president of the organization (www.americanbariatricconsultants.com). All this translates into 164 million Americans who are overweight or obese looking for help from professionals in an industry where more than 40 billion dollars are spent out of pocket each year on their health care.

It should only follow that if the obese population is on the rise, then the need for bariatric products, services, and training/education for rehabilitation specialists is even greater. PTs and exercise physiologists, for example, have become an essential part of the treatment team, along with dieticians, nutritionists, the physician/surgeon, and case manager (usually a registered nurse). Bariatric rehabilitation now incorporates a multidisciplinary approach to treatment because of the added issues of mobility, flexibility, muscle strength, endurance, and the addition of regular exercise. For the purposes of this article, we will discuss which products PTs/rehab specialists/exercise physiologists are using most, what they are used for, how and why they are used, and the benefits to their clients.

TRANSFER/LIFT DEVICES

"Transfer devices are leading the way mainly because of the injuries from caring for these patients," Huffman says. With a 500-pound patient, PTs, home health care providers, and nurses in the hospital setting are getting injured with the larger patients. "The bariatric industry is developing lift chains and lift/transfer equipment that is specifically designed for patients of that size," he adds. Huffman consults with Ohio-based Gendron Inc (www.gendroninc.com), a company that develops, designs, and manufactures bariatric patient care products for acute, long-term, and home care as well as rehabilitation environments. The company's bariatric products include beds and accessories; manual and power wheelchairs; bathing, toiletry, and ambulatory items; long-term and acute care equipment; transport products; and stretchers.

Gendron also has a team of engineers that goes in and looks at the patient and the health care provider and develops equipment to reduce injury risk to the provider. "You're always concerned with the risk of the patients, too," Huffman emphasizes, "and want to make sure they get transported safely." However, it's costly to have a health care worker injured, not to mention the costs of retraining or hiring a new person. "It's much more cost-effective to implement new bariatric equipment [from the start]," he states.

"I think the lifts have really made a difference in our hospital in general," says PT Kristi Fregia Rucks of Wausau Bariatrics in Wisconsin (www.wausaubariatrics.com). "We used to have the mentality of holding a patient up on parallel bars and writing, ‘Patient could stand for 30 seconds, with max assist of three,' " she says. "The reasons [he] only stood for 30 seconds is that I got tired. I couldn't hold [him] up any longer than that. Now you have this equipment that's there so you have extra hands to do some of your other manual therapies and not try to hold the patient up at the same time."

OTHER OPTIONS

Back in the 1990s, the physical therapy department in the Gundersen Lutheran Health System (www.gundluth.org) of La Crosse, Wis, had committees that were working on patient handling and injuries. "If you look back, there weren't really a lot of choices for equipment," says Gary Brunslik, safety manager. Gundersen includes a 325-bed teaching hospital and a Level II Trauma Center, serving patients throughout western Wisconsin, northeastern Iowa, and southeastern Minnesota, providing care in 19 counties. The ceiling lifts were installed in units hospital wide. "Our physical therapy department was one of the first areas we started putting lift equipment in," he says. In hydrotherapy, they were having difficulties assisting patients into the therapy pools because of the size of the patient. "We put a large rail system overhead mounted in the ceiling in that area, and it is used to transfer patients from treatment tables into the hydrotherapy pools or tubs," he says. "When we did that, we started looking at the physical therapy area itself."

One particular day, Brunslik watched staff assisting a patient down a set of parallel bars. There was a staff person on each side of the patient and another staff member following behind with a wheelchair. "We had a situation where there was one patient and three staff members—a 3:1 ratio." Following that, Brunslik suggested putting an aid or transfer system above the parallel bars with two rails between the set of rails along with another rail with a motor, free to move up and down those parallel rails. "We have vest/ambulatory slings that go around the chest and hip, and by placing these on patients, they can then walk down the parallel bars with no more than one staff member. If they were to become weak, dizzy, or fall in any way, the lift catches them. "We've effectively reduced the patient-to-staff ratio from 3:1 to 1:1. It's better utilization of staff."

Gundersen works with Liko USA (www.liko.com/na). Its products range from compact, lightweight mobile lifts to high-capacity overhead systems and an extensive line of slings and lifting accessories. Brunslik says they also have a rail system that runs along the wall on the opposite side of the gymnasium where patients can be assisted from a wheelchair onto a treatment table and an overhead system that goes over their treadmills. In the outpatient unit, they also installed a ceiling lift so they can assist patients up on the treatment tables without having to put themselves or the patients at risk.

Gundersen has about 270 ceiling lifts to date, which have helped significantly reduce injuries to both patients and staff, as well as days of staff restricted time and lost days.

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TREATMENT TABLES

The Bailey Manufacturing Company (www.baileymfg.com) in Lodi, Ohio, manufactures bariatric treatment tables. Models include a 1,000-pound bariatric treatment table, an adjustable back bariatric treatment table, and a bariatric mat table, to name a few of its product lines. Bailey can customize its products by request, so, for example, if you need a 10-foot-long bariatric mat table, consider it done. One particular table like this was made in two sections and assembled on-site at a facility in Lithonia, Ga. Please refer to the company's Web site for specific details.

Todd Harry, AuD, of the Fingerlakes Hearing and Balance Center (www.fingerlakeshearing.com) in Canandaigua, NY, says the purpose of the bariatric table is for balance testing at their facility. "It must be fairly large and stable due to the need to have patients put into different positions during testing," he says. "This particular table is nice because of the size. Patients don't have a fear of falling off the table while they are moving on it." Harry adds that the reclining back is also ideal for balance testing. "For some tests we need patients to be flat on their backs while other tests require more of a 45-degree angle." Fingerlakes Hearing and Balance Center is a full-service hearing care practice specializing in the fitting of the latest digital hearing aid technology. Recently, it began balance testing and tinnitis retraining therapy.

TRAINING

Huffman works with PTs in hospitals, extended care facilities, and at home. "We do a couple of types of training," he says, "from sensitivity training and how to treat patients with dignity, to how to use the equipment with patients." Huffman does training independently, and Gendron offers training with its own equipment. Huffman also offers continuing education programs for physical and occupational therapists, visiting a variety of teaching institutions and state or regional professional societies. He'll also do an assessment for a facility asking questions about its typical volume while gathering data on its Web site. Then he'll send someone out to the facility to do measurements, look at support structure, types of equipment, where the equipment is located, etc, and provide guidance on any potential medicolegal risks of the current equipment.

"I think an important thing to do is to look at the nitty-gritty of everything you're using," Fregia Rucks adds. "For example, a waiting room chair. Does it have the proper weight limit?" Then follow the patient along the way and think about him/her coming into the waiting room. Is your exam room chair accommodating enough in terms of weight capacity? Even a commode is something to consider. Different brands have different weight limits. You don't want to get a bunch of 1,000-pound-capacity commodes," Rucks stresses. "What if you have someone who weighs 300 pounds? It's like sitting on a big throne. It feels weird."

ROLE OF PHYSICAL THERAPY

My personal clientele is all bariatric surgery patients right now," Fregia Rucks says. "A couple of weeks out of surgery, it's important to work on core stability. They've just had major abdominal surgery—even if it's laparoscopic—they need strength training." At about 6 months, these patients will have some trouble with their balance because they have lost so much weight; it's in the way they carry it. "They'll need balance training and postural education," she says. "Around the 1-year mark, they have to remember that exercise will keep them going strong into the future and [achieve fitness] success."

Exercise and activity are just a part of achieving and maintaining weight loss and should really begin before surgery. The focus is to improve overall mobility, flexibility, muscle strength, and endurance, and establish a routine.

ACCEPTANCE

On the other side of the coin, although it can be fairly easy to install specialized equipment, the hard part is changing the culture of the facility. Staff is usually trained to work manually with patients and then to come in with mechanical equipment; it takes time to get trained and accept a new way of doing things. Gundersen has four universities in its system, and two of them have nursing programs where they are now purchasing this type of equipment to train students before they come to the hospital. "They (students) are now starting to be aware of that equipment before they come into the hospital. We're accelerating the process. Working with the bariatric population is a lot more involved than the 'ordinary' patient," Brunslik says.

CENTERS OF EXCELLENCE

The American Society for Metabolic and Bariatric Surgery (ASMBS) is the largest society for this specialty in the world. Its goal is to improve public health and well-being by lessening the burden of the disease of obesity and related diseases.

Founded in 1983 with leadership from some of the United States' foremost surgeons, the society has established educational and support programs for surgeons and integrated health professionals. A bariatric facility or clinic/practice that provides this type of rehabilitation service can be awarded "Center of Excellence" status from the ASMBS (www.asmbs.org), which is becoming a standard for bariatric surgical practices. It requires comprehensive treatment protocols that American Bariatric Consultants develop for their bariatric surgical clients. Relative to rehabilitation specialists, integration of these standards of care presurgical and postsurgical of programs into current bariatric practices can help them meet their organization's criteria for this status.

Nina Silberstein is a contributing writer for Physical Therapy Products. For more information, contact .

Reference

1. Used with permission. Mission and purpose. The American Society for Metabolic and Bariatric Surgery, Gainesville, Fla. Available at: www.asmbs.org/Newsite07/aboutasbs/asbs_mission.htm. Accessed December 8, 2009.