Weight monitoring for wheelchair users, bedbound and bariatric clients - Specialist Nutrition Rehab

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13 Dec 2023

Weight monitoring for wheelchair users, bedbound and bariatric clients

 

Monitoring a client’s weight regularly (e.g. monthly) after a catastrophic injury is essential.  Clients are often discharged from hospital and rehabilitation settings weighing significantly less than their “pre-injury” weight.  This is due to drastic changes to muscle mass (as a result of inflammation, immobility and insufficient protein intake) and/or frequent periods of being “nil by mouth” in hospital due to surgeries and procedures.  After discharge, however, weight tends to go one of two ways — clients either struggle to regain the weight they lost or they gain significant amounts of weight and end up becoming overweight or obese.

 

Catching problems early is the key — but clients will need to be weighed regularly in order to accomplish this.

Why monitor weight?

If someone unintentionally LOSES 10% of their body weight within a span of 3-6 months, that puts them at extremely high risk of malnutrition which warrants a referral to a dietitian (NHS or private).1  This is outlined in the Malnutrition Universal Screening Tool (MUST) and a MUST score should be part of every case manager’s initial needs assessment.  The MUST score also ties in nicely if you are doing the Waterlow score to assess pressure ulcer risk.

Similarly, if someone unintentionally GAINS 10% of their body weight within a 3-6 month period, this also justifies a referral to a dietitian.  This is because unintentional weight gain flags up issues with the client’s current routines, lifestyle and eating habits. If a dietitian can intervene early (before habits and routines become too embedded), it can be significantly easier for clients, families and staff to make the required changes.  As you can imagine, helping someone lose 1 stone in weight requires less dietetic input versus clients who need to lose 4-5 stone.  Many clients really struggle to come to terms with the fact that they simply cannot eat the same quantity of food that they did before their accident without gaining weight.  This is because from ~2 months post-injury, they will usually have a much lower metabolic rate as a consequence of their reduced muscle mass (meaning they burn fewer calories) .

In terms of weight monitoring, stand-on scales are easy to come by and most mobile clients under 150kg will often be weighed at hospital appointments and in GP surgeries.  Clients can also buy these scales with very little expense.  In contrast, the most vulnerable clients who are unable to stand, rarely get weighed.  GP surgeries generally don’t have appropriate scales and while hospitals are all supposed to be weighing clients at every admission, the reality is that this very rarely gets done (even when the clients request it).  That means clients can go YEARS without anyone monitoring their weight, which then makes it impossible to catch problems early.

Here are the top 5 options for weighing wheelchair-users, bedbound and/or bariatric clients:

 

1.  Check with local physiotherapy and/or prosthetic clinics.

Some physiotherapy and/or prosthetic clinics have wheelchair scales available to help clients monitor their weight.  If clients are travelling to these clinics anyways (to receive other forms of rehabilitation), this can be a quick and cost effective way to get the weight information you need.

 

2.  Order hoists & beds with integrated scales

After a major trauma, clients often require the purchase of new equipment to support them. Whenever possible, ask the Occupational Therapist to order hoists and beds which come with integrated scales.  Just make sure to confirm that the scale component can be calibrated every 12 months (at a minimum) when the hoist or bed is serviced.  While external hoist scales do exist, some are only compatible with the coat-hanger style spreader bars which are becoming much less common.  Also, adding an external scale to an existing hoist can lengthen the hoist cable.  This creates issues with hoisting the client high enough (or lowering the bed sufficiently), to suspend the client completely off of the bed to get an accurate weight reading.  A hoist or bed with an integrated scale avoids these issues and is therefore the preferred option.

 

3.  Have clients purchase their own wheelchair scale

If clients are expected to use a wheelchair long-term, purchasing their own wheelchair scale can be a good investment.  There are a few brands which can be tipped on their side and stored up against the wall to keep them out of the way.  Here are the four least expensive options.

Note: several companies will sell these specific models so be sure to shop around to get the best price.

Be aware of the weight limit and dimensions for each scale.  You want to ensure the scale will accommodate the weight of the client + the weight of their wheelchair.  Some clients may choose to transfer to a manual wheelchair or shower chair in order to be weighed if their scale has a lower weight limit.  Clients using a power wheelchair will definitely need the higher weight limit (just make sure the wheelbase of their chair will fit on the platform).

We do NOT recommend the wheelchair weigh beam scales, for a number of reasons: 1) because it is incredibly difficult to line up the beams with the front and back wheels on the client’s wheelchair, 2) the wheels on electric wheelchairs are generally not compatible and 3) the beams are not wide enough for the front wheels to turn if you want to reverse the client off the scale.  We’ve also experienced issues with weight accuracy depending on where the wheelchair is positioned on the beams.

 

4.  Utilise a patient weighing service

If clients only need a one-off weight for a report or assessment, then you may want to look into the Benmor Medical Patient weighing service.  They have reps nation-wide, and will send someone out to weigh the client using a bed weigher or wheelchair scale (including bariatric clients).  The cost as of December 2023 was £500 +VAT per weighing (which includes travel).  To use their bed weigher, clients need to have a bed with single-caster wheels.  You either need to know the make and model of the bed and mattress (so this weight can be deducted) or you need to have a way to lift the client off the bed in order to obtain the weight of the bed + mattress separately.  They need at least one other person present (preferably a health professional) to assist with rolling the client onto the scale.

 

5.  Other options for bariatric clients

While bariatric clients are able to use any of the options listed above (depending on the weight of the client), they don’t always need something as bulky as a wheelchair scale.  Here are some other options:

  • Marsden M-530 (500kg weight limit)
  • Seca 635 (300kg weight limit but clients can stand, use their zimmer frame or place a chair on the scale)

 

Of course other types of scales exist, but these options tend to be much less commonly used:

Contact us to discuss which scale may be most suitable for your client or check out InscaleSeca, and Marsden to see all of the options available.

If you are collecting weight data, then make sure the care team are using this information and acting on it appropriately.  For training staff on how to weigh patients and interpret the results, or if you want to refer a client who has unintentionally gained or lost 10% of their body weight, please contact Specialist Nutrition Rehab on 0121 384 7087 or info@specialistnutritionrehab.co.uk.

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