Disclosures: Carlos A. Rodriguez, Jr., DO: HCA Healthcare (MountainView Hospital) (Products/Services: No) (Employment)

Case Diagnosis: A 52-year-old male with motor vehicle accident (MVA)-related polytrauma.

Case Description: Patient presented to the Emergency Department with multiple organ lacerations, as well as facial, rib, vertebral, and pelvic fractures. After surgery and 10 days of acute care, he was transferred to Inpatient Rehab on strict non-weight bearing (nWB) precautions with sliding board transfers per Orthopedist recommendations. On Rehab Days (RD) 1-5, the patient presented with somnolence and confusion. He was transferred to acute care for 3 days due to suspected PE. Upon return to Inpatient Rehab, Care TOOL scores failed to demonstrate significant improvement (RD 6-24) until removal of nWB precautions. The patient was successfully discharged to home with home health services on RD 40.

Setting: Inpatient acute rehabilitationAssessment/

Results: Prior to removal of nWB precautions, the patient’s functional Care TOOL scores were 13/42 (ratio 0.31) on admission, 14/36 (0.39) on RD 5, 12/24 (0.5) on RD 7, and 28/54 (0.52) on RD 24. After removal of nWB precautions, Care TOOL scores improved to 48/66 (0.72) on RD 35, and 71/72 (0.99) on RD 40 (Date of Discharge). Ambulation distances were 8’ with parallel bars on RD 24, 176’ with front wheel walker (FWW) on RD 28, 506’ without durable medical equipment (DME) on RD 31, and >600’ without DME on RD 39. Upon Discharge, inpatient pain regimen, including opioids Oxycodone and Percocet, was reduced to Gabapentin 100mg TID, and bowel regimen was no longer needed.

Discussion: Considering this patient’s Rehab course, earlier advancement of weight-bearing status in cases of polytrauma may correspond to lower complication rate, a decreased pain and bowel regimen requirement, a shorter Rehabilitation stay, and an increased likelihood of successful return to home.

Conclusion: According to the existing literature, timing of weight-bearing (WB) restriction is not strictly defined. Further research may be indicated concerning the optimal time course of WB precautions.

Level of Evidence: Level IV

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/improved-care-tool-scores-of-a-polytrauma-patient-after-removal-of-strict-weight-bearing-precautions-a-case-report/