ABSTRACT
OBJECTIVE: To investigate the effects of body mass index (BMI) on the rehabilitation process in patients with a recent knee replacement. DESIGN: This retrospective cohort study included all patients admitted to a rehabilitation hospital, with a recent diagnosis of knee replacement and available hospital admission data including height and weight, between 2014 and 2017. SETTING: Rehabilitation hospital. PARTICIPANTS: Study participants included patients who had undergone knee replacement surgery (N=742), with available BMI data. INTERVENTIONS: None. MAIN OUTCOME MEASURES: FIM scores, including FIM change per day (FIM efficiency) by BMI category. RESULTS: The chart review identified 742 patients who had undergone knee replacement surgery, with available BMI data. The identified patients ranged in age from 58 to 85 years, with a mean age of 70 years. Of the patients included in the study, 24 were male, 49 were female, 73 were within the normal weight class, 180 in the overweight class, 189 in the obese class I, 143 in the obese class II, and 157 patients were classified as obese class III. The mean FIM efficiency was highest in the obese class II category (3.96). In a multivariate analysis after controlling for age, obese classes II and III had significantly better FIM efficiency. CONCLUSION: This study did not demonstrate that obesity adversely affects the rate of recovery during hospitalization after knee replacement surgery.
ABSTRACT
BACKGROUND: Lifestyle medicine is the science and application of healthy lifestyles as interventions for the prevention and treatment of disease, and has gained significant momentum as a specialty in recent years. College is a critical time for maintenance and acquisition of healthy habits. Longer-term, more intensive web-based and in-person lifestyle medicine interventions can have a positive effect. Students who are exposed to components of lifestyle medicine in their education have improvements in their health behaviors. A semester-long undergraduate course focused on lifestyle medicine can be a useful intervention to help adopt and sustain healthy habits. OBJECTIVE: To describe a novel, evidence based curriculum for a course teaching the concepts of Lifestyle Medicine based on a web-based course offered at the Harvard Extension School. METHODS: The course was delivered in a web-based format. The Lifestyle Medicine course used evidence based principles to guide students toward a "coach approach" to behavior change, increasing their self-efficacy regarding various lifestyle-related preventive behaviors. Students are made to understand the cultural trends and national guidelines that have shaped lifestyle medicine recommendations relating to behaviors. They are encouraged to engage in behavior change. Course topics include physical activity, nutrition, addiction, sleep, stress, and lifestyle coaching and counseling. The course addressed all of the American College of Preventive Medicine/American College of Lifestyle Medicine competencies save for the competency of office systems and technologies to support lifestyle medicine counseling. RESULTS: The course was well-received, earning a ranking of 4.9/5 at the school. CONCLUSIONS: A novel, semester-long course on Lifestyle Medicine at the Harvard Extension School is described. Student evaluations suggest the course was well-received. Further research is needed to evaluate whether such a course empowers students to adopt behavior changes.
ABSTRACT
OBJECTIVE: To assess whether and how effectively an interactive presentation about lifestyle medicine could impact the knowledge and attitudes of medical students to prepare them for managing chronic conditions in their patients. Chronic diseases are increasingly prevalent and problematic. Although chronic disease management involves lifestyle modification, few physicians are adequately trained in effective motivational interventions. METHODS: We surveyed first- and second-year Harvard Medical School students in October 2015 before and after a presentation on lifestyle medicine and quantified changes in their knowledge, attitudes/confidence, and skills. RESULTS: Medical students learned the basics of behavioral change after a 1-hour presentation, and their confidence with regard to implementing interventions increased. Median scores of confidence in counseling patients on lifestyle changes improved as did their ability to counsel patients on exercise, nutrition, sleep, stress management, and smoking cessation. CONCLUSIONS: After a brief intervention, medical students can learn principles of behavioral management and how to implement the skills with patients suffering from chronic illnesses.