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

Tingting Zhang,Bianca Jambhekar,Amit Kumar,Syed A Rizvi,Linda Resnik,Theresa I Shireman

doi:10.1016/j.msard.2019.03.003

Abstract

BackgroundThe 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. ObjectiveThe 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. MethodsWe 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. ResultsA 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). ConclusionPwMS 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.

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