Assessing the effects of post-acute rehabilitation services on health care outcomes for people with multiple sclerosis

Mult Scler Relat Disord. 2019 May:30:277-283. doi: 10.1016/j.msard.2019.03.003. Epub 2019 Mar 5.

Abstract

Background: The impact of post-acute rehabilitative services provided in skilled nursing facilities (SNF) on a particularly vulnerable, disabled subgroup, namely persons with multiple sclerosis (PwMS), is unknown.

Objective: The objectives of this study were to (1) describe the use of post-acute rehabilitative services in SNFs, and (2) examine the association between the use of physical and occupational therapy (PT/OT) and (a) successful community discharge and (b) functional improvement for PwMS.

Methods: We retrospectively selected PwMS newly admitted to a SNF from the hospital between January 2008 and September 2012. Using the Minimum Data Set (MDS), we examined the receipt of PT/OT and categorized the receipt as high and low intensity PT/OT according to median hours/week. We assessed the association of high vs. low PT/OT with successful discharge to the community and functional improvement using propensity-matched logistic regression.

Results: A total of 26,412 PwMS had valid OT/PT values in the MDS during the study period, among which 24,410 (92.4%) used PT/OT for some time in the SNF. Median PT/OT use was 9.7 h/week. Use of rehabilitation services was higher in patients with less cognitive and functional impairment. Overall, two-thirds (67.3%) of the propensity matched cohorts for Objective 2a (n = 8204/group) were successfully discharged to community; and one-third (33.6%) of the matched cohort for Objective 2b (n = 6803/group) had improved function. Higher PT/OT therapy was associated with successful discharge [odds ratio (OR) 1.20; 95% CI 1.12-1.28] and functional improvement (OR 1.21; 95% CI 1.13-1.30).

Conclusion: PwMS used post-acute rehabilitation services at SNFs for a median of ∼10 h/week. Those who used more rehabilitative services in the post-acute care setting were more likely to be successfully discharged to the community and experience functional improvement after adjustment for major confounders.

Keywords: Functional improvement; Multiple sclerosis; Rehabilitation; Skilled nursing facility; Successful discharge to community.

MeSH terms

  • Activities of Daily Living
  • Aged
  • Aged, 80 and over
  • Cohort Studies
  • Delivery of Health Care / methods*
  • Disabled Persons
  • Female
  • Humans
  • Logistic Models
  • Male
  • Middle Aged
  • Multiple Sclerosis / psychology
  • Multiple Sclerosis / rehabilitation*
  • Occupational Therapy / methods*
  • Patient Discharge
  • Physical Therapy Modalities*
  • Skilled Nursing Facilities
  • Treatment Outcome*