Disclosures: Tina Bijlani, DO: Nothing to disclose

Case Description: The patient was initially admitted to the hospital for an allogenic bone marrow transplant for treatment of transfusion-dependent JAK2+ myelofibrosis. Hospital course complicated by Grade IV graft-versus-host disease (GVHD), acute bronchiolitis secondary to RSV, multiple recurrences of sigmoid volvulus requiring flexible sigmoidoscopy, severe protein-calorie malnutrition, paralytic ileus, and gram-negative bacilli bacteremia. The patient was initially bed bound since admission in March 2018 until admission to inpatient rehabilitation 10 months later, at which point he endorsed significant weight loss, weakness, muscle atrophy, and gait instability. A major barrier that prevented optimal therapy was intermittent diffuse abdominal pain from revolvulization; however, patient was not deemed a surgical candidate due to comborbidities.

Setting: Acute Inpatient Rehabilitation Unit

Patient: A 63-year-old male with myelofibrosis resulting in severe debility.

Assessment/Results: In the first month, patient’s course was limited by fatigue, but by the second month his functional status significantly improved as well as his ambulation and abilities to negotiate stairs. Nearing the end of his inpatient rehabilitation stay, his functional status significantly improved with the ability to ambulate 100 ft with rolling walker, increased stair negotiation, and increased stamina. He also significantly improved his functional status from requiring moderate assistance for most ADLs to contact guard assist. Initially thought to require long-term care placement, this patient made significant improvement and instead was discharged home.

Discussion: This case highlights the utilization of IPR and interdisciplinary medicine in patients with chronic disease and prolonged hospitalization. While the disease state may not be reversible, their quality of life may be significantly enhanced. Patients may no longer require lifelong assistance and can gain functional independence.

Conclusion: Debilitating chronic disease can lead to prolonged hospitalization. IPR plays a pivotal role in improving functional status, coordinating care with various specialties, and facilitating discharge planning. Ultimately, this decreases the burden on the patient and maximizes independence.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/reviewing-the-significance-of-acute-inpatient-rehab-in-a-patient-with-chronic-debility/