Rehabilitation and Physical Therapy

Effectively improve patient health, functionality, and mobility

Disclaimer: InBody devices should be used as an adjunct tool for clinical decision-making and are not intended to diagnose or treat any diseases

Why is body composition analysis an effective tool in physical therapy?

Body composition is essential for understanding the patient’s physiological makeup and guiding treatment to target specific areas for improvement in physical therapy programs. InBody devices are non-invasive and convenient, making them the ideal tool to implement in rehabilitation practices. The InBody test provides comprehensive results that can be used to educate and engage patients as well as track improvements throughout the course of physical therapy treatment.

In less than 90 seconds, the InBody Test provides easy-to-understand, accurate, and objective measurements to evaluate the patient’s starting point and monitor progress during rehabilitation. Physical therapists can use the InBody to:

Assess muscle distribution and target areas weakened by injury or surgery
Identify fluid imbalances related to inflammation or postoperative edema
See improvements in cell membrane health that will improve outcomes
Monitor changes to determine the efficacy of an exercise program and guide recommendations to ensure long-term success

SEGMENTAL LEAN ANALYSIS

Assess patient frailty status and functional mobility risk

Current clinical methods of measuring body composition are either indirect or costly when more advanced, limiting its application. InBody provides a cost-effective, comprehensive, and timely measurement of segmental lean mass, which can be used to identify areas of weakness due to injury or surgery.

The Segmental Lean Analysis (SLA) section promptly assesses a patient’s frailty status and functional mobility risk. SLA can identify and target the improvement of areas of low lean mass, reducing the risk of falls and/or injuries. The top bar of the SLA provides an objective measure of fat-free mass, while the bottom bar analyzes:

The ability of a segment to support the patient’s overall body weight

Insufficient lean development in a particular segment

Using the information given in the SLA, tailored rehabilitation programs could be designed. These programs can account for imbalances due to loss of muscle in separate segments related to the current injury and/or overcompensation or immobility. Further, the risk of lower limb musculoskeletal injury, due to asymmetry, may be a concern for physical therapy patients. A study by Kozlenia et al., 2022 that women with higher skeletal muscle mass asymmetry are at an increased risk for lower limb injury, indicating that previous injuries could intensify the existing asymmetry.

Appropriately tailored interventions, as outlined in this study by Thapa et al., 2022 help increase functional fitness and mobility and reduce the risk of re-injury. Physical therapists can use the information provided by InBody to improve overall health, return patients to their previous baseline, and reduce health risks of re-injury.

SKELETAL MUSCLE MASS INDEX

Assess the patient’s sarcopenia status and frailty

A low Skeletal Muscle Mass Index (SMI) can increase the risk of falls or sarcopenia. Therapists can utilize SMI values as a tool to improve patients’ outcomes as shown by, Sueyoshi et al., 2022. His study discusses the benefits of rehabilitation with a focus on increasing low SMI to improve activities of daily living in elderly patients with vertebral compression fractures, as well as independent risk factors between low SMI, loss of function, and post-surgical complications. As such, the integration of SMI can better assist physical therapists in creating treatment plans that increase successful patient outcomes. Furthermore, different working groups have defined SMI cutoff values that can serve as guidelines. The Asian Working Group for Sarcopenia defined bioimpedance cutoffs as <7.0 kg/m2 for men and <5.7 kg/m2 for women. The European Working Group also established cutoffs as seen in the excerpt of the article below:

ARTICLE

Skeletal Muscle mass Index (SMI) is an indicator of muscle degradation, by analyzing Sarcopenia

European Working Group on Sarcopenia in Older People published revised European Consensus that the SMI cut-off for men is 7.0 or 5.5 for women. Using these cut-off values, muscle degradation can be evaluated.

ECW/TBW RATIO ANALYSIS

Improving rehab outcomes and avoiding re-injury

Following surgery or injury, inflammation can occur with little to no visible symptoms. Objective and precise measures of body water can detect water retention and inflammation to help guide rehabilitation treatment.

InBody effectively distinguishes water in the intracellular (ICW; within the tissues) and extracellular (ECW; within the blood and interstitial fluids) water compartments that comprise total body water. The Edema Index, based on the ratio between ECW and TBW (ECW/TBW), can be used to detect fluid imbalances resulting from inflammation due to injury or recovery after surgery.

By assessing fluid balance in the body and by specific segments, inflammation can be identified and used to guide treatment options and intensity to reduce the risk of re-injury or post-surgery complications.

A study by Chung & Kim, 2021 discusses the importance of ECW ratio analysis in post-surgery complications for fluid management of critically ill patients. These measures are provided for the whole body, and for each segment. They can be used to identify fluid imbalances that may be occurring, offering a more precise analysis, an early indication of inflammation, and recovery. Tracking these values back to a patient’s baseline will aid therapists in validating the success of a tailored rehabilitation program.

PHASE ANGLE

Assess how water distribution affects cell health

Phase angle (PhA) is a direct measure of cell integrity and water distribution. In healthy humans, the cell membrane consists of a layer of non-conductive lipid material between two layers of conductive fluids (body water). When there are two conducting materials surrounding an insulator, this is often referred to as a capacitor. Cell membranes contain the important parts of a cell and regulate unwanted toxins and waste.

Higher PhA values are integral for better overall cellular health, while low PhA values are indicative of decreased muscle strength and quality of life, as referenced in a study by Lim & Lim, 2020. For this purpose, PhA can serve as a predictor of functional status in patients undergoing postoperative rehabilitation.

Additionally, a study by Abe et al., 2021, proposes that PhA may be a useful independent predictor of physical function and rehabilitation in stroke patients. By providing therapists with a parameter for muscle quality assessment, the improvement of a patient’s functional outcome at discharge can be afforded.

BODY COMPOSITION HISTORY

Track trends of patient progress to monitor the success of the program

Frequently, patient progress may be tracked through subjective measurement screenings and patient-reported outcomes, making it harder to track progress precisely and objectively. Objective measures of weight, skeletal muscle mass, percent body fat, and ECW/TBW allow progress in body composition and inflammation to be recorded and tracked throughout a rehabilitation program.

InBody’s Body Composition History section allows patients and physical therapists to monitor progress over the course of physical therapy programs. An article by Niazi et al., 2020. highlights the importance of body composition history within sports rehabilitation to improve athletic performance.

Improvements can be tracked to ensure rehabilitation programs are improving the client’s musculature, body composition, and functionality. Martins et al., 2022 discuss how visualization of progress keeps patients motivated and engaged in their treatment plans. Long-term monitoring of ECW/TBW can track decreases in inflammation following the surgery or injury as well as monitor for increases that may be indicative of irritation or overtraining. Negative trends can be identified more effectively and addressed to improve the patient’s long-term health, functionality, and mobility.

ACTUAL CASE

After 6 weeks of rehabilitation

– Strengthening training was performed

– Prescribed with extra milk and proteins

The patient’s initial Skeletal Muscle Mass was 15.4kg and it was increased up to 16.1kg after having rehabilitation.

While, ECW Ratio has been decreased up to 0.393 which shows that edema or inflammation has been alleviated.

With Whole Body Phase Angle, which was improved from 3.8 to 4.3, it can be evaluated that general health status has been improved.

Based on the body compositions, it can be evaluated that patient is on proper recovery.