Scientific Paper: Characteristics and Functional Level of Patients with Polyneuropathy Post Bariatric Surgery at Inpatient Rehabilitation Centres in Riyadh, Saudi Arabia

Objectives
The primary objectives of this study are to assess the functional level and outcomes of patients with polyneuropathy post bariatric surgery before and after inpatient rehabilitation program. Also, to identify characteristics of polyneuropathy in our population and determining the success of rehabilitation services.

Design
This was an observational cross-sectional study. Medical records of patients with polyneuropathy from two rehabilitation centers from 2008 to 2019 were screened against our inclusion criteria (age from 14 years and above, first admission in rehabilitation center with polyneuropathy post bariatric surgery and polyneuropathy was defined by clinical criteria with the corresponding nerve conduction studies/electromyography results. A total of 281 patients with polyneuropathy across the two centers were filtered and 269 of them were excluded due to either lack of sufficient data or not meeting our inclusion criteria.

We created a Google Form for manual entry of demographic data , Functional Independence Measure (FIM) and the presenting symptoms. Data was extracted and analyzed using Statistical Package for the Social Sciences (SPSS) for the following tests (paired sample test, chi-square and t-test) with a descriptive analysis of the data.

Results
A total of 12 patients were included, evenly split between males and females. The mean age was 24.68 ± 6.09 years, and most were single. Generalized weakness was universal, while numbness, respiratory muscle involvement, dysphagia, vomiting, and facial weakness appeared less often; imbalance, dysautonomia were rare.

Patients showed notable functional gains. Mean FIM scores improved from 84.42 ± 24.58 on admission to 110.08 ± 13.60 at discharge, a significant increase of 25.67 ± 19.50 points (t(11) = –4.561, p < .001). Most motor-related FIM areas improved significantly(stairs 0.001 , toileting 0.02, lowerlimb dressing 0.003) whereas cognitive items remained high and stable.

Dysautonomia correlated positively with FIM improvement, and vomiting and dysphagia showed moderate associations, though none reached significance. Treatment outcomes varied: Intravenous Immunoglobulin (IVIG) produced the greatest mean improvement (ΔFIM 34.5), followed by plasma exchange (29.3) and conservative care (21.7), though differences were not statistically significant.
Conclusions
This study demonstrates that patients with polyneuropathy post bariatric surgery experienced substantial functional improvement during inpatient rehabilitation, reflected by significant gains in overall FIM scores and across most motor-related domains. Clinical features such as dysautonomia, vomiting, and dysphagia showed positive associations with functional change, though the small sample limited statistical significance.
Among treatment modalities, IVIG was associated with the greatest functional improvement, followed by plasma exchange and conservative management. Overall, these findings highlight the effectiveness of rehabilitation in restoring function in our patients and underscore the need for larger studies to better clarify predictors of recovery.
Research Study with Best Paper Award Abstract
Objectives
This study aimed to measure the prevalence and functional recovery of polyneuropathy patients post bariatric surgery before and after inpatient rehabilitation program using Functional Independence Measure (FIM) and the associated characteristics of the polyneuropathy.

Design
This was an observational cross-sectional study. The medical records of patients with polyneuropathy from two rehabilitation centers from 2008 to 2019 were screened against our inclusion criteria (age from 14 years and above, first admission in rehabilitation center with polyneuropathy post bariatric surgery and polyneuropathy was defined by clinical criteria with the corresponding nerve conduction studies/electromyography results. A total of 281 patients with polyneuropathy across the two centers were filtered and 269 of them were excluded due to either lack of sufficient data or not meeting our inclusion criteria.
We created a Google Form for manual entry of demographic data, Functional Independence Measure (FIM) and the presenting symptoms. Google Form data sheets were extracted into Excel format and analyzed using Statistical Package for the Social Sciences (SPSS) for the following statistical tests (paired sample test, chi-square and t-test) and a descriptive analysis of the data

Results
A total of 12 patients were included in the study, with equal numbers among males (n = 6, 50%) and females (n = 6, 50%). The mean age of the participants was 24.68 ± 6.09, and most patients were single (n = 9, 75%). The most common presenting symptoms were general weakness (100%), followed by numbness (41.7%), respiratory muscles weakness (25%), dysphagia (16.7%), vomiting (16.7%), facial weakness (16.7%); with the least common collectively being imbalance and dysautonomia (8.3%).
Patients demonstrated marked improvements in FIM score. The mean FIM scores improved considerably between admission (84.42 ± 24.58) and discharge (110.08 ± 13.60), with a mean gain of 25.67 ± 19.50 points. This shift in FIM scores differed reliably from a shift of zero, t(11) = –4.561, p < .001, (95% CI –38.05, –13.28). A large effect size was noted (Cohen’s d = –1.317; Hedges' g = –1.271), indicating marked clinically significant improvements.
The majority of FIM areas demonstrated significant improvement between admission and discharge; Locomotion Stairs (p = .001) Toileting (p =.002), Tub transfer (p =.002), Lower limb dressing (p =.003).
Dysautonomia had a positive correlation with function improvement (r = .67). Treatment modalities showed some variability in FIM score improvement. patients who received IVIG (n = 6) showed highest improvements (mean ΔFIM 34.5, p = .099). Plasma exchange (n = 3) provided a moderate improvement (mean ΔFIM 29.3, p = .528), whereas conservative management (n = 3) presented lower improvements (mean ΔFIM 21.7, p = .091).

Conclusion
This study demonstrates that patients with polyneuropathy post bariatric surgery experienced substantial functional improvement during inpatient rehabilitation, reflected by significant gains in overall FIM scores and across most motor-related domains. Clinical features such as dysautonomia, vomiting, and dysphagia showed positive associations with functional change, though the small sample limited statistical significance. Among treatment modalities, IVIG was associated with the greatest functional improvement, followed by plasma exchange and conservative management. Overall, these findings highlight the effectiveness of rehabilitation in restoring function in our patients and underscore the need for larger studies to better clarify predictors of functional recovery.