RE: Gastric Bypass Program (PT)

[Guest guest]

We provided this type of service for a brief time when one of our general

surgeons offered the banding procedure for the bariatric population. We were

utilized as more of a screening and educational tool for the patient

pre-operatively. It was part of the pre-operative testing and was not billed as

a separate PT evaluation. If during this assessment, we discovered

musculoskeletal dysfunctions that limited the client's ability to exercise, we

would recommend PT. A brief explanation of the procedure is as follows. After

completing a health questionnaire and subjective assessment and if the patient

could perform it, a submaximal V02 test by walking a mile on the treadmill was

performed. Some treadmills can calculate this for you if it can monitor heart

rate and has the ability to do a " fit test " . If not, there is a formula to use.

The formula can be reference in an article by Kline et.al. in Medicine and

Science in Sports and Exercise 19, no. 3 (1987):23-59. We have not performed

this service in a few years so I would see if there is any up to date research

in this area. The sub maximal VO2 test was used to determine a fitness level.

Based on this result, subjective exam, and any other needed musculoskeletal exam

we thought indicated, we would prescribe an exercise program including

strengthening, flexibility, and general conditioning with target heart rate. We

would also meet with the physician plus nursing, dietary, and pysch to discuss

if the patient was a good candidate for surgery. If they were too physically

limited to perform exercises, we did not believe them to be a good candidate.

We would give them goals to achieve and if they meet them, we would reassess to

see if they were a surgical candidate. If for instance knee pain was a limiting

factor, we would try regular PT to address it and see if they could then become

physically active. This all depended on their rehab potential. Post

operatively, they were expected to continue this program. They did not perform

this on a cash basis with us since we do not have the space in our clinic.

I hope this helps. If you need any more info, let me know.

M. Trevor Huffman, P.T., M.S., S.C.S., A.T.C.

Director of Rehabilitation Services

Passavant Area Hospital

ville, IL

trevor.huffman@...<mailto:trevor.huffman@...\

>

________________________________

From: PTManager [mailto:PTManager ] On Behalf Of

mnk1990

Sent: Thursday, January 03, 2008 1:00 PM

To: PTManager

Subject: Gastric Bypass Program (PT)

Hi group,

I was contacted by an area physician who is interested in our clinic

providing services for his patients who are candidates for Gastric

Bypass Surgery. Is there anyone who has developed a program for

their clinic? If so, could you please give me some feedback on how

you've setup the program & how it is working? You can contact me by

phone or personal email if that works better for you, but since this

is a growing area I would guess that some on the listserv are

interested as well.

I am most curious about the referring dx, freq & duration of

therapy. The physician indicated he would like his referral to

facilitate weightloss, conditioning, functional mobility &

flexibility; of course there are usually other medical dxs

associated with this population. There are other disciplines

involved as well, like dietary, mental health, etc. He states he

would need this for 6 months. So ultimately, my question gets down

to, do you think we (physical therapy) can justify the level of

skilled service for this patient population vs. assessment, setting

up a program & sending them to a personal trainer who we would have

to trust is maintaining the recommendations of the program? Any

input to how you've set up your programs are appreciated. Thanks

for your feedback & ideas in advance!

Mike Kamp, OTR/L, CEAS

Rehab Supervisor

Onslow Memorial Hospital

ville, NC

mike.kamp@...<mailto:mike.kamp%40onslowmemorial.org>

Phone (910)577-2288