Accidental Prehabilitation: a case of increased exercise frequency before thoracic surgery
UMass Chan Affiliations
Department of Radiation OncologyDepartment of Surgery
Department of Orthopedics and Physical Rehabilitation
Document Type
PosterPublication Date
2020-03-08Keywords
case studyhealth insurance
physical therapy
inpatient
exercise
thoracic surgery
Cardiovascular Diseases
Health Services Administration
Insurance
Orthopedics
Physical Therapy
Surgery
Metadata
Show full item recordAbstract
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-t567Permanent Link to this Item
http://hdl.handle.net/20.500.14038/43012Notes
Poster presentation at the 2020 International Society of Physical and Rehabilitation Medicine World Congress, Orlando, FL, March 8, 2020.
Rights
Copyright 2020 the Authorsae974a485f413a2113503eed53cd6c53
10.13028/w0dm-t567