Survey of Rehabilitation Medicine Physicians: Rehabilitation of patients with morbid obesity

Question Title

* 1. What are your areas of practice? Please select all that apply:

Adult rehabilitation medicine

Paediatric rehabilitation medicine

Neurological rehab e.g. stroke, brain injury, spinal cord injury

General rehab e.g. orthopaedic, reconditioning, amputee

Intellectual disability

Pain medicine

Obesity medicine

Non-clinical e.g. management, admin, teaching, research

Medicolegal

Retired / on leave

Other (please specify)

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* 2. Where is your practice located? (Please answer for your primary practice)

Country:

State / City:

Hospital / Clinic:

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* 3. Over the last 12 months, on average what proportion of your patient cohort would you estimate to have morbid obesity (BMI > 40kg/m2)? Please select one:

Majority (greater than 50%)

Around 50%

25-50%

10-25%

Less than 10%

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* 4. Which rehab models of care does your practice currently offer to patients with morbid obesity? Please select all that apply:

Acute rehab or “in-reach” rehab (joint care with an acute team)

Inpatient admission, with access to acute services

Inpatient admission, without access to acute services e.g. standalone facility

Day hospital program (non-admitted, reviewed by multidisciplinary team)

Outpatient clinic (not reviewed by multidisciplinary team)

Rehabilitation in the home

Rehabilitation program in nursing home or transitional accommodation

Telehealth rehab

Other (please specify)

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* 5. How does your facility access bariatric equipment (specialised beds, scales, hoist, mobility aids etc)? Please select all that apply:

Own stock

Hires from external suppliers

Internal organisational equipment loan pool

Does not have access

Not applicable

Don’t know

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* 6. Does your health service have a dedicated person, working group, committee or similar examining the needs of patients with morbid obesity? Please select one

Yes

I don’t know

Not applicable

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* 7. Do you have specialist medical support and / or expertise to manage the acute needs and comorbidities of patients with morbid obesity in your practice? Please select one:

Yes

Not applicable

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* 8. How would you evaluate your knowledge of best practice for managing weight loss in morbidly obese patients? E.g. Current guidelines, pharmacological intervention, dietary intervention, exercise intervention, surgical intervention, referral pathways etc. Please select one:

Excellent knowledge (expert)

Good knowledge

Minimal knowledge

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* 9. Would you be interested in additional education and training for managing weight loss in patients with morbid obesity? Please select one:

Yes

Not applicable

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* 10. In your opinion, do you think that morbid obesity should be classified as a disability?

Yes

Not sure

Please provide a comment if you wish

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* 11. What do you feel are some of the most useful measures of success in relation to managing patients with morbid obesity? Please select all those that apply:

Patients achieving their identified goals

Patients regaining their independence e.g. mobility, ADLs

Satisfactory patient-reported evaluation of service

Satisfactory Functional Independence Measure (FIM) change or efficiency

Satisfactory length of stay comparable to patients without obesity and similar impairment(s)

Good feedback from rehab staff

None of the above

Not applicable

Other (please specify)

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* 12. How have institutional factors related to morbid obesity limited the potential effectiveness of your patients' rehabilitation? Please select all those that apply:

No significant institutional limiting factors

Non-acceptance of patients with morbid obesity to rehab e.g. due to limited facilities, equipment, staffing numbers

Increased length of stay compared to non-obese patients with similar impairment

Decreased FIM efficiency compared to non-obese patients with similar impairment

Occupational health and safety of staff or patients

Lack of suitable nutrition options

Insufficient rehab staff numbers

Inadequate rehab staff expertise managing patients with morbid obesity

Inadequate rehab staff cultural awareness training

Weight bias / staff attitudes to people with morbid obesity

Inadequate facilities for patients with morbid obesity e.g. rooms, doorways

Inadequate equipment (e.g. beds, mobility devices, hoists) for patients with morbid obesity

Not applicable

Other (please specify)

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* 13. How have personal/social factors related to morbid obesity interfered with your patients' rehabilitation? Please select all those that apply:

No interference

Patient's lack of readiness for change

Insufficient carer / family support

Patient adverse events

Difficulty managing associated physical comorbidities e.g. sleep / respiratory disorders, diabetes, pain, infections, DVT/PE etc

Difficulty managing associated psychological comorbidities e.g. depression, eating disorders, anxiety, PTSD etc

Other (please specify)

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* 14. What factors do you feel would enable more effective rehabilitation of patients with morbid obesity? Please select all those that apply:

None

Improved staff expertise managing morbid obesity and comorbidities

Improved staff cultural awareness education and training options

Appropriate rehab staffing

Patient advocacy and reducing weight stigma / bias

Improved access to equipment specific for patients with morbid obesity

Improved access to facilities specific for patients with morbid obesity

Improved access to weight loss clinics or obesity specialists

Improved access to specialist care to manage comorbidities e.g. respiratory physician, endocrinology

Improved access to appropriate nutrition options

Change in benchmarking using AROC data e.g. increased estimated length of stay for patients with morbid obesity

Effective family and carer education sessions

Use of assistive technology e.g. Fitbit, remote monitoring, Telerehab

Not applicable

Other (please specify)

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* 15. Which weight loss strategies do you routinely incorporate as part of the rehab plan for your patients with morbid obesity? Please select all those that apply:

None

Dietitian intervention

Patient, family and carer education

Caloric restriction / diet

Pharmacological intervention

Referral to obesity specialists e.g. clinic, physician, surgeon

Referral to other specialists e.g. sleep physician, endocrinologist

Psychological intervention

Exercise

Use of assistive technology e.g. Fitbit, remote monitoring, Telerehab

Not applicable

Other (please specify)

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* 16. It has been proposed that multidisciplinary rehabilitation services have the potential to complement existing weight management services. In your opinion in which ways could this be achieved? Please select all those that apply:

Pre-hab (multidisciplinary intervention aimed at managing disability and weight loss, prior to weight loss surgery)

Post-operative admission to inpatient rehabilitation units

Post-operative outpatient rehabilitation services

Joint care of patients known to rehab services e.g. spinal cord injury

Additional resources for an understaffed weight management clinics e.g. management of pain and musculoskeletal injury, access to allied health e.g. physiotherapy, occupational therapy if not available in clinic

Long-term maintenance rehabilitation program to reduce relapse

Alternative service e.g. for those that are not eligible for weight loss surgery or further management in weight loss clinic

Alternative resources for those unable to attend weight loss clinic due to distance or other reasons

Research e.g. high quality studies to determine optimal exercise intervention (type, duration, intensity, frequency) for improved metabolism, weight loss and functional gains for patients with morbid obesity

Other (please specify)

Survey of Rehabilitation Medicine Physicians: Rehabilitation of patients with morbid obesity

Question Title

* 1. What are your areas of practice? Please select all that apply:

Question Title

* 2. Where is your practice located? (Please answer for your primary practice)

Question Title

* 3. Over the last 12 months, on average what proportion of your patient cohort would you estimate to have morbid obesity (BMI > 40kg/m2)? Please select one:

Question Title

* 4. Which rehab models of care does your practice currently offer to patients with morbid obesity? Please select all that apply:

Question Title

* 5. How does your facility access bariatric equipment (specialised beds, scales, hoist, mobility aids etc)? Please select all that apply:

Question Title

* 6. Does your health service have a dedicated person, working group, committee or similar examining the needs of patients with morbid obesity? Please select one

Question Title

* 7. Do you have specialist medical support and / or expertise to manage the acute needs and comorbidities of patients with morbid obesity in your practice? Please select one:

Question Title

* 8. How would you evaluate your knowledge of best practice for managing weight loss in morbidly obese patients? E.g. Current guidelines, pharmacological intervention, dietary intervention, exercise intervention, surgical intervention, referral pathways etc. Please select one:

Question Title

* 9. Would you be interested in additional education and training for managing weight loss in patients with morbid obesity? Please select one:

Question Title

* 10. In your opinion, do you think that morbid obesity should be classified as a disability?

Question Title

* 11. What do you feel are some of the most useful measures of success in relation to managing patients with morbid obesity? Please select all those that apply:

Question Title

* 12. How have institutional factors related to morbid obesity limited the potential effectiveness of your patients' rehabilitation? Please select all those that apply:

Question Title

* 13. How have personal/social factors related to morbid obesity interfered with your patients' rehabilitation? Please select all those that apply:

Question Title

* 14. What factors do you feel would enable more effective rehabilitation of patients with morbid obesity? Please select all those that apply:

Question Title

* 15. Which weight loss strategies do you routinely incorporate as part of the rehab plan for your patients with morbid obesity? Please select all those that apply:

Question Title

* 16. It has been proposed that multidisciplinary rehabilitation services have the potential to complement existing weight management services. In your opinion in which ways could this be achieved? Please select all those that apply:

Question Title

* 17. Please provide additional comments if you wish