Assessing the Effects of Post-Acute Rehabilitation Services on Health Care Outcomes for People with Multiple Sclerosis
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 approximately 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.
Zhang, T., Jambhekar, B., Kumar, A., Rizvi, S., Resnik, L., & Shireman, T. (2019). Assessing the Effects of Post-Acute Rehabilitation Services on Health Care Outcomes for People with Multiple Sclerosis. Multiple Sclerosis and Related Disorders, 30, 277-283. https://doi.org/10.1016/j.msard.2019.03.003