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    Accidental Prehabilitation: a case of increased exercise frequency before thoracic surgery

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    Authors
    Baima, Jennifer
    Maxfield, Mark W.
    Powers, Maggie
    Varlotto, John M.
    Uy, Karl
    UMass Chan Affiliations
    Department of Radiation Oncology
    Department of Surgery
    Department of Orthopedics and Physical Rehabilitation
    Document Type
    Poster
    Publication Date
    2020-03-08
    Keywords
    case study
    health insurance
    physical therapy
    inpatient
    exercise
    thoracic surgery
    Cardiovascular Diseases
    Health Services Administration
    Insurance
    Orthopedics
    Physical Therapy
    Surgery
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    Abstract
    Case Diagnosis: 67 year-old man was found down with dysarthria, dysphagia, and right lower limb weakness. He was diagnosed with left anterior cerebral artery ischemic stroke, acute renal failure, atrial fibrillation, and deep venous thrombosis. He remained hospitalized for months as he did not have insurance for inpatient rehabilitation care and could not be safely discharged home. Case Description: During that time, he got physical therapy 5 times per week and then 2 times per week. While hospitalized, he was subsequently diagnosed with left upper lobe nodule from T2aN0M0 lung adenocarcinoma. Physical therapy was increased back to 5 times per week for at least two weeks prior to left upper lobectomy and mediastinal lymphadenectomy by video-assisted thorascopic surgery 2.5 months after admission. Hospital course was complicated by anticoagulation and postoperative hemothorax, which responded to evacuation. He was discharged to subacute care after rate negotiation and then home. Discussions: We present the case of a patient who got physical therapy five times weekly in the 14 days prior to thoracic surgery. Although it is well established that exercise improves aerobic parameters and outcomes, the typical outpatient insurance benefit is under 120 minutes or only twice per week. 150 minutes a week is the current recommended amount of exercise for cancer patients. Since this patient could not be discharged due to lack of insurance for acute rehabilitation or outpatient care, he remained inpatient and received physical therapy five times weekly prior to surgery. Despite risk factors, he was safely discharged and recovered well. Conclusions: Our patient got a greater frequency and higher dose of exercise than most presurgical thoracic patients; this may be why he was able to tolerate thoracic surgery with multiple serious risk factors.
    DOI
    10.13028/w0dm-t567
    Permanent Link to this Item
    http://hdl.handle.net/20.500.14038/43012
    Notes

    Poster presentation at the 2020 International Society of Physical and Rehabilitation Medicine World Congress, Orlando, FL, March 8, 2020.

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    Copyright 2020 the Authors
    ae974a485f413a2113503eed53cd6c53
    10.13028/w0dm-t567
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    Orthopedics and Physical Rehabilitation Publications

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