Difficulty in Obtaining Functional Mobility Gains with Physical and Occupational Therapy in a Malnourished Patient: A Case Report

Background: Nutritional anemia is due to deficiency of one or more nutrients required for hematopoiesis. It can be reversed by increasing the amount of deficit nutrients consumed. The role that nutritional anemia can play in physical therapy is not well studied. Purpose: The purpose of this case report is to describe poor functional mobility progression observed in one patient that had several co-morbidities, including nutritional anemia in an inpatient rehabilitation setting. Patient History: The patient is a 37-year-old female reporting to an inpatient rehabilitation facility after an acute hospital stay following her diagnosis of hypokalemia, severe protein malnutrition, and hypovolemic shock. The patient had difficulty keeping her food down prior to hospital admission. Upon admission to inpatient rehabilitation, she had a BMI of 15.85. Intervention: The patient received 15 days of physical and occupational therapy for a total of three hours per day, five days a week. Physical therapy consisted of lower extremity strengthening, endurance, and core exercises, all focusing on functional mobility. Outcome Measures: Manual muscle test results and Functional Index Measures (FIM scores) were used to monitor this patient’s progress in addition to her lab values. More objective outcome measures such as the Five Times Sit to Stand, Timed Up and Go, and Handheld Dynamometry would have been beneficial to measure on this patient due to her deficits. Discussion: This patient’s lack of significant progress during rehabilitation was likely due to her medical status. Her low nutrient consumption, hypotension, and edema impacted her functional abilities and strength. Had the patient received formal nutrition education, motivational interviewing, and/or mental health therapy these other effects may have been minimized and she may have returned home sooner with improved lab values and health status. Therefore, this case suggests that nutritional status is one additional factor that therapists may need to consider when treating patients.