Use Of Rehabilitation Services Research Articles

Associations of Participation-Focused Strategies and Rehabilitation Service Use With Caregiver Stress After Pediatric Critical Illness

Objective(s)Determine the associations between having participation-focused strategies and receiving rehabilitation services in the pediatric intensive care unit (PICU) with caregiver stress over 6 months post-PICU discharge. DesignSubstudy of a data from Wee-Cover, a prospective cohort study. SettingTwo PICU sites. ParticipantsCaregivers (N=168) of children 1-17 years old admitted into a PICU for ≥48 hours. Main Outcome MeasuresData were collected from caregivers at enrollment and 3 and 6 months post-PICU discharge. Caregiver stress was assessed using the Pediatric Inventory for Parents. Having strategies to support their child’s participation in home-based activities was assessed using the Participation and Environment Measure (PEM). In PEM, caregivers report on strategies used to support their child’s participation in home-based activities. Data were dichotomized (yes, no) to denote having participation-focused strategies and if their child received PICU rehabilitation services. Additional covariates were history of a preexisting condition, child age, length of PICU stay, and change in functional capacities at PICU discharge. ResultsHistory of a preexisting condition, time, and change in functional capacities significantly predicted caregiver stress frequency and difficulty. The interaction of having strategies-by-rehabilitation-by-time significantly predicted caregiver stress frequency and difficulty. Conclusion(s)Results highlight the role of early rehabilitation and the importance of working with caregivers to develop participation-focused strategies to support their child’s functioning post-PICU. Families of children with a preexisting condition or those who experience a decrease in function during a PICU stay are susceptible to higher levels of stress and may be a priority population to target for rehabilitation services.

Effects of Strategies and Rehabilitation Service Use on Caregiver Stress Following Pediatric Critical Illness

To determine how participation focused strategies and rehabilitation service use in the pediatric intensive care unit (PICU) impact caregiver stress over six months post-discharge.

State-Level Variation in Vocational Rehabilitation Service Use and Related Outcomes Among Transition-Age Youth on the Autism Spectrum.

Employment outcomes for transition-age youth with autism spectrum disorder (TAY-ASD) following Vocational Rehabilitation (VR) services declined between 2002 and 2011; although a few states showed significant progress. We examined inter-state variation in VR service use and outcomes among TAY-ASD in 2014-2016, finding significant differences in the percentage of TAY-ASD who received VR services, entered VR services during secondary school, had timely development of an employment plan, and were employed at VR exit. Inter-state differences remained significant after adjusting for the influence of individual-level demographics and state-level unemployment and fiscal capacity, suggesting other factors influence variation. Future research should monitor whether changes in the VR program, via the 2014 Workforce Innovation and Opportunity Act, move the needle on VR outcomes for TAY-ASD.

Rehabilitation Services Use of Older Adults According to Fall-Risk Screening Guidelines.

To characterize rehabilitation services use of older adults according to fall-risk classification based on screening guidelines. Cross-sectional analysis of 2015 National Health and Aging Trends Study. Study participants' homes. National sample of 7,440 community-dwelling Medicare beneficiaries. In-person interviews and functional assessments. Based on Centers for Disease Control and Prevention Stopping Elderly Accidents, Deaths and Injuries criteria, participants were classified as low, moderate, or high fall risk. Twenty-three percent of older adults classified as moderate fall-risk (n = 2602) and 40.6% of those at high fall-risk (n = 940) reported rehabilitation services use in the past year. Among older adults who reported rehabilitation services in the past year (n = 1,505), treatment to address falls was reported by 2.8%, 12.6%, and 34.7% of those classified with low, moderate, and high fall-risk, respectively (p < 0.001). Older adults with high fall-risk who did not receive rehabilitation services had significantly better self-reported physical capacity (p = 0.02) but comparable physical performance (all p's > 0.05) relative to those who received rehabilitation. Older adults at high risk for falls were significantly more likely to report rehabilitation services use compared to those with low and moderate risk of falling. The findings also indicate that there is low adherence to national clinical recommendations for rehabilitation services use in older adults vulnerable to falls-related injury. Among the high fall-risk group, those who did not receive rehabilitation services had similarly low physical function as compared with those who received rehabilitation, indicating potential unmet need to address physical impairments related to fall-risk. J Am Geriatr Soc 67:100-107, 2019.

Perception of blind rehabilitation services among adults with acquired blindness in Nigeria: Attention to functional goals

Like other sub-Saharan African nations, Nigeria has a relatively high proportion of adults with acquired vision loss. This study investigates the impacts of becoming blind in adulthood and how the use of blind rehabilitation services addresses functional needs, supports activities of daily living, and enhances participation in educational, vocational, and community activities. Adopting a qualitative and interpretative approach, we conducted in-depth interviews with eight adult users of blind rehabilitation services. Three broad themes were identified: (1) psycho-emotional responses to vision loss; (2) impacts on participation in education, employment, and community; and (3) positive impact of blind rehabilitation services. Findings are discussed in the context of the international literature, and suggestions that may enhance the blind rehabilitation services are made.

Rehabilitation service utilisation among adults with intellectual disabilities: Trends and socioeconomic disparities in China.

Intellectual disabilities (IDs) have become a public health concern worldwide, but few studies on rehabilitation service utilisation in this population were conducted in developing countries. We aimed to examine trends and socioeconomic disparities in the utilisation of rehabilitation services among adults with IDs in China. We obtained data from a population-based survey by using a multistage, randomised, cluster sampling process to ascertain adults with IDs in 2006 and a selected subsample for follow-up surveys during 2007-2013. Psychiatrists ascertained individuals with IDs ascertained by intelligence quotient score under 70, deficits in two or more adaptive behaviours and age of onset under 18years. Overall, the utilisation rate of rehabilitation services significantly increased from 10.1% in 2007 to 33.7% in 2013, with an annual average percentage growth of 34.3% when adjusting for multiple confounders. The mounting trends remained significant in all socioeconomic groups. The growth rates among lower socioeconomic participants were much higher than those among higher socioeconomic participants, and the strength in the association between socioeconomic position (education and region) and rehabilitation service utilisation declined in 2007-2013. This study found an upward trend in rehabilitation service utilisation in Chinese adults with IDs during 2007-2013, and socioeconomic disparities in rehabilitation service use in this population showed a downward trend over time.

Socioeconomic determinants of outcome after childhood arterial ischemic stroke.

To determine whether lower socioeconomic status (SES) is associated with worse 1-year neurologic outcomes and reduced access to rehabilitation services in children with arterial ischemic stroke (AIS). From 2010 to 2014, the Vascular effects of Infection in Pediatric Stroke (VIPS) observational study prospectively enrolled and confirmed 355 children (age 29 days-18 years) with AIS at 37 international centers. SES markers measured via parental interview included annual household income (US dollars) at the time of enrollment, maternal education level, and rural/suburban/urban residence. Receipt of rehabilitation services was measured by parental report. Pediatric Stroke Outcome Measure scores were categorized as 0 to 1, 1.5 to 3, 3.5 to 6, and 6.5 to 10. Univariate and multivariable ordinal logistic regression models examined potential predictors of outcome. At 12 ± 3 months after stroke, 320 children had documented outcome measurements, including 15 who had died. In univariate analysis, very low income (<US $10,000), but not other markers of SES, was associated with worse outcomes (odds ratio [OR] 3.13, 95% confidence interval [CI] 1.43-6.88, p = 0.004). In multivariable analysis, including adjustment for stroke etiology, this association persisted (OR 3.17, 95% CI 1.18-8.47, p = 0.02). Income did not correlate with receiving rehabilitation services at 1 year after stroke; however, quality and quantity of services were not assessed. In a large, multinational, prospective cohort of children with AIS, low income was associated with worse neurologic outcomes compared to higher income levels. This difference was not explained by stroke type, neurologic comorbidities, or reported use of rehabilitation services. The root causes of this disparity are not clear and warrant further investigation.

Association between the intensity of outpatient rehabilitation therapy and the risk of dementia in patients of ischemic stroke

Patients with stroke have an increased risk of dementia. Some studies have found that outpatient rehabilitation programs may improve cognitive function in chronic stroke patients. However, little is known about the use of rehabilitation in the outpatient setting and its impact on the risk of dementia. The objective of this study was to examine the association between the intensity of outpatient rehabilitation services received and the risk of dementia. We used the National Health Insurance Research Database in Taiwan to identify 16,264 patients diagnosed with stroke from 1997 to 2005. Rehabilitation intensity was categorized as none, low, medium or high based on the sum of physical therapy, occupational therapy, and speech therapy within the first 6 months after discharge from inpatient rehabilitation. Cox proportional hazard regression models were used to evaluate the association between the intensity of rehabilitation and the risk of dementia. During the follow-up period (median, 7.5 years), 1429 patients were diagnosed with incident dementia. Compared to patients in the no rehabilitation group, those who received high intensity therapy had a decreased risk of dementia during the follow-up period (hazard ratio: 0.68; 95% confidence interval: 0.56–0.84). The results remained consistent in analyses stratified by gender. The intensity of outpatient rehabilitation therapy and the risk of dementia was significantly inversely related in the ischemic stroke patients. Thus, further programs aimed at promoting greater use of outpatient rehabilitation services in patients with stroke are warranted.

Association of use of rehabilitation services with development of osteoporosis among patients with rheumatoid arthritis: a nationwide population-based cohort study.

People with rheumatoid arthritis have increased risk of developing osteoporosis (OP). It remains unclear whether use of rehabilitation services can reduce the risk of developing OP. We conducted a longitudinal cohort study to compare the effect of RS on the risk of OP in Taiwanese individuals with RA. A national health insurance database was used to identify 2693 newly diagnosed RA patients, 20-70years old, between 1998 and 2007. Among them, 808 received RS after the onset of RA (RS users) and 1885 patients did not receive RS (non-RS users). All enrollees were followed until the end of 2012 to record incident cases of OP. A Cox proportional hazards regression model was used to compute adjusted hazard ratios (aHRs) for the relationship of use of RS with OP. During the 15-year follow-up, 358 RS users and 1238 non-RS users developed OP, corresponding to incidence rates of 87.24 and 129.27 per 1000 person-years, respectively. Use of RS was significantly associated with a lower risk of OP (aHR 0.62; 95% confidence interval [CI] = 0.56-0.71). Those who received more than five sessions of RS had the greatest benefit (aHR 0.47; 95% CI = 0.38-0.56). The integration of RS into the clinical management of patients with RA may decrease their risk of developing OP.

Comparing post-acute rehabilitation use, length of stay, and outcomes experienced by Medicare fee-for-service and Medicare Advantage beneficiaries with hip fracture in the United States: A secondary analysis of administrative data.

BackgroundMedicare Advantage (MA) and Medicare fee-for-service (FFS) plans have different financial incentives. Medicare pays predetermined rates per beneficiary to MA plans for providing care throughout the year, while providers serving FFS patients are reimbursed per utilization event. It is unknown how these incentives affect post-acute care in skilled nursing facilities (SNFs). The objective of this study was to examine differences in rehabilitation service use, length of stay, and outcomes for patients following hip fracture between FFS and MA enrollees.Methods and findingsThis was a retrospective cohort study to examine differences in health service utilization and outcomes between FFS and MA patients in SNFs following hip fracture hospitalization during the period January 1, 2011, to June 30, 2015, and followed up until December 31, 2015. We linked the Master Beneficiary Summary File, Medicare Provider and Analysis Review data, Healthcare Effectiveness Data and Information Set data, the Minimum Data Set, and the American Community Survey. The 6 primary outcomes of interest in this study included 2 process measures and 4 patient-centered outcomes. Process measures included length of stay in the SNF and average rehabilitation therapy minutes (physical and occupational therapy) received per day. Patient-centered outcomes included 30-day hospital readmission, changes in functional status as measured by the 28-point late loss MDS-ADL scale, likelihood of becoming a long-term resident, and successful discharge to the community. Successful discharge from a SNF was defined as being discharged to the community within 100 days of SNF admission and remaining alive in the community without being institutionalized in any acute or post-acute setting for at least 30 days. We analyzed 211,296 FFS and 75,554 MA patients with hip fracture admitted directly to a SNF following an index hospitalization who had not been in a nursing facility or hospital in the preceding year. We used inverse probability of treatment weighting (IPTW) and nursing facility fixed effects regression models to compare treatments and outcomes between MA and FFS patients. MA patients were younger and less cognitively impaired upon SNF admission than FFS patients. After applying IPTW, demographic and clinical characteristics of MA patients were comparable with those of FFS patients. After adjusting for risk factors using IPTW-weighted fixed effects regression models, MA patients spent 5.1 (95% CI -5.4 to -4.8) fewer days in the SNF and received 463 (95% CI to -483.2 to -442.4) fewer minutes of total rehabilitation therapy during the first 40 days following SNF admission, i.e., 12.1 (95% CI -12.7 to -11.4) fewer minutes of rehabilitation therapy per day compared to FFS patients. In addition, MA patients had a 1.2 percentage point (95% CI -1.5 to -1.1) lower 30-day readmission rate, 0.6 percentage point (95% CI -0.8 to -0.3) lower rate of becoming a long-stay resident, and a 3.2 percentage point (95% CI 2.7 to 3.7) higher rate of successful discharge to the community compared to FFS patients. The major limitation of this study was that we only adjusted for observed differences to address selection bias between FFS and MA patients with hip fracture. Therefore, results may not be generalizable to other conditions requiring extensive rehabilitation.ConclusionsCompared to FFS patients, MA patients had a shorter course of rehabilitation but were more likely to be discharged to the community successfully and were less likely to experience a 30-day hospital readmission. Longer lengths of stay may not translate into better outcomes in the case of hip fracture patients in SNFs.

Utilization of medical rehabilitation services among older Poles: results of the PolSenior study

BackgroundRehabilitation tailored to older adults’ needs might improve their functional performance and quality of life, as well as increase social participation. The aim of the study was to evaluate the use of medical rehabilitation services among older Poles in relation to socio-economic and health-related determinants.Materials and methodsData regarding medical rehabilitation were obtained from the nationwide, multidisciplinary PolSenior project (2007–2012) conducted on representative sample of 4813 respondents (48.3% women) aged 65+ years. Socio-economic status, physical functioning, falls, chronic pain, and formal disability occurrence, as well as self-rated health were accounted for.ResultsOne in six respondents (18.9% women vs. 15.8% men, p < 0.005) underwent medical rehabilitation during 12 months prior to the survey. Respondents mostly received electrotherapy or light radiation therapy (61.3%). Multivariate logistic regression analysis revealed that women aged 80+ years and men aged 90+ years had a significantly lower chance of using rehabilitation services compared to the youngest study participants (65–69 y.o.). City dwellers used rehabilitation services nearly twice as frequently as rural dwellers. Respondents with university education level were most likely to take part in these services. Dependence in IADL decreased participation in medical rehabilitation, while formal disability and chronic pain promoted utilization of rehabilitation services.ConclusionsYounger age, city dwelling, higher education, functional independence, formal disability certificate, and chronic pain increased participation in medical rehabilitation. Such results of the study should be considered in planning actions towards reducing health inequalities at the national level and promoting health and well-being among older adults.

Spatial Disparities in Access and Use of Rehabilitation Services in Northern Greece: a GIS-based Study

Spatial Disparities in Access and Use of Rehabilitation Services in Northern Greece: a GIS-based Study

Can Older Adults Accurately Report Their Use of Physical Rehabilitation Services?

ObjectiveTo explore the accuracy of rehabilitation service use reports by older adults as well as variation in accuracy by demographic characteristics, time since use, duration, and setting (inpatient, outpatient, home). DesignLongitudinal observational study. SettingParticipants' homes. ParticipantsCommunity-dwelling adults ages 65 and older (N=4228) in the 2015 National Health and Aging Trends Study who were enrolled in Medicare Parts A and B for 12 months before their interview. InterventionsNot applicable. Main Outcome MeasuresRespondents were asked whether they received rehabilitation services in the past year and the duration and location of services. Healthcare Common Procedure Coding System codes and Revenue Center codes were used to identify Medicare-eligible rehabilitation service. ResultsSurvey-based reports and Medicare claims yielded similar estimates of rehabilitation use over the past year. Self-reported measures had high sensitivity (77%) and positive predictive value (80%) and even higher specificity and negative predictive value (approaching 95%). However, in adjusted models, sensitivity was lower for black enrollees, the very old, and those with lower education levels. ConclusionsSurvey-based measures of rehabilitation accurately captured use over the past year, but differential reporting should be considered when characterizing rehabilitation use in certain subgroups of older Americans.

Healthcare resources utilisation in primary progressive multiple sclerosis.

Epidemiological data on primary progressive multiple sclerosis (PPMS) are scarce. This study was aimed to evaluate the burden of PPMS in Italy with healthcare resources utilisation and costs for Italian National Health System (INHS). A 2-year cross-sectional analysis of real-world data collected in the ARCO database, covering > 10 million Italian inhabitants, was performed. From a cohort of patients affected by MS in 2014, those supposedly affected by PPMS were defined by the concurrent matching of absence of disease-modifying treatments and use of rehabilitation services. Any other drug prescriptions, outpatient services and hospitalisations were analysed in 2015 for each subject. The average annual cost per patient was provided both for each expenditure item and by integrating these. Of 13,253,591 inhabitants, 18,453 resulted affected by MS (prevalence 139 × 100,000). Of these, 1849 agreed with additional criteria to identify PPMS (10% of MS population). The 26.8% of these experienced at least one admission in 1year, 97.3% used at least one outpatient service and 94.3% received at least one reimbursed drug. In the perspective of INHS, PPMS generated an average annual cost of € 3783 per person: 49% for hospitalisations, 28% for outpatient services and 23% for drugs. This study provides a reliable estimation of the PPMS burden in Italy, in terms of healthcare utilisation and direct costs. These findings could be useful to estimate the changes in health expenditure following the incoming of new drugs to treat PPMS with increase of pharmaceutical cost and potential decrease of rehabilitation and hospitalisation costs.

Illicit drug use and violence in acute psychosis among acute adult admissions at a South African psychiatric hospital

The prevalence of mental illness and illicit substance use has increased markedly in South Africa's Western Cape Province, over the last 2 decades; potentially increasing demand for psychiatric care. This paper describes the demographic and substance use profile of patients admitted to Lentegeur (LGH), the largest of the four psychiatric hospitals in the Province. Medical records, patient interviews and other clinical notes were used to collect data on demographics, illicit substance use, violent behaviour and utilization of rehabilitative services for patients (n=535) admitted to LGH between 1 August 2012 and 31 January 2013. Majority of admissions were male (65.6%) and younger (69.8% < 35 years) compared to females (62.6% >35 years). Overall, 255 (49%) used an illicit substance, (24% females and 63% males). Majority of substance users were youth (18-35 years) in both males (83.1%) and females (73.8%). Cannabis and methamphetamine were the most popular drugs in males (56.3% and 34.9%) and females (17.9% and 16.2%) with the highest rates being among the youth. Violence was common among both men (60.7%) and women (40.8%); among the violent, 67% of males and 35.6% of female used substances. Only 5.5% of drug users utilized formal drug rehabilitation services. Substance use and violence were high, yet only a small proportion of the patients utilised available drug rehabilitation services. This may have implications on psychotic relapses, morbidity and subsequent pressure on financial resources within the health care system. Efforts are needed to maximise utilisation of existing rehabilitative resources for these patients.

Factors Influencing Institutional-Based Pediatric Rehabilitation Services among Caregivers of Children with Developmental Delay in Southwestern Rajasthan.

Context:A limited number of caregivers of children with developmental delay access rehabilitation facilities in India. The study explored utilization of rehabilitation services at a tertiary care setup in southwestern Rajasthan and various factors influencing it.Aims:The aim of this study is to explore rehabilitation service utilization among children with developmental delay at a tertiary care setup and to ascertain factors that influence this pattern.Settings:This study was conducted at the department of physical medicine and rehabilitation at tertiary care setup.Design:This was an observational study.Subjects and Methods:Children with developmental delay who were advised institutional-based rehabilitation were identified over span of 1 year. Those who failed to return for rehabilitation after the first visit were interviewed telephonically. The interview had semi-structured open-ended questions about their reasons for inability to avail services.Statistical Analysis:SPSS statistics 22 was used for descriptive analysis and correlation of variables.Results:Of 230 children with developmental delay visiting department in 1-year duration, 48 took regular rehabilitation. Parents of 129 children with complete records were asked regarding discontinuation. Factors cited by majority were long distance from institute and service at hospital. Other reasons for discontinuation were related to belief system, family issues, time issues, socioeconomic factors, etc. Socioeconomic status was significantly associated with parental education (C = 0.488, P = 0.000) and financial issues. Location of family had significant association with long distance (C = 0.315, P = 0.000), parental education (C = 0.251, P = 0.003), and belief system (C = 0.265, P = 0.002).Conclusions:Distance from institute and quality of hospital service determined rehabilitation service use at a tertiary institute. Other factors such as socioeconomic status, family support, and social belief system must also be addressed while delivering institutional rehabilitation to children.

Catastrophic health expenditure among households with members with special diseases: A case study in Kurdistan.

Background: One of the main goals of health systems is to protect people against financial risks associated with diseases that can be catastrophic for patients. In 2014, Health Sector Evolution Plan (HSEP) was implemented in Iran; one of the objectives of HSEP was to reduce out-of-pocket payments and provide more financial protection for people. Therefore, the present study aimed at exploring the likelihood of facing catastrophic health expenditures (CHE) among households with members suffering from dialysis, kidney transplant, or multiple sclerosis (MS) after the implementation of HSEP. Methods: A total number of 385 households were selected using stratified random sampling and were asked to complete the World Health Survey questionnaire through telephone conversations. As outlined by the World Health Organization (WHO), when household out-of-pocket expense for health services is ≥40% of its capacity to pay, then that household is considered to be facing CHE. Furthermore, determinants of CHE were identified using logistic regression. Results: The percentage of facing catastrophic health care expenditures for households with a MS, dialysis, and kidney transplant patient was 20.6%, 18.7%, and 13.8%, respectively. Results of logistic regression analysis revealed that patient’s economic status, level of education, supplementary insurance status, type of disease, multiple members with special diseases in the household, rural residence, use of inpatient, dental, and rehabilitation services were effective factors for determining the likelihood of facing CHE. Conclusion: Despite the implementation of HSEP, the percentage of CHE is still high for households that have members who suffer from special diseases. However, basic health insurance packages should be amended and more cost-sharing exemptions should be granted to provide more financial protection for the vulnerable households.

Relation of depressive symptoms to outcome of CI movement therapy after stroke.

Depressive symptoms after stroke have been associated with negative outcomes, including poorer functional ability, less efficient use of rehabilitation services, decreased quality of life, and increased mortality. It has been anecdotally noted that depressive symptoms do not limit motor recovery in patients who undergo Constraint-Induced Movement Therapy (CIMT), an efficacious intervention for chronic poststroke hemiparesis. Here we analyze depressive symptom and motor scores from 40 participants who received CIMT in 2 previously published studies. Adults more than 1-year after stroke with mild to moderate upper-extremity hemiparesis completed the Zung Self-Rating Depression Scale and Motor Activity Log (MAL) before and after CIMT. We used regression analysis to test whether Zung scores predicted response to CIMT and paired t tests to test whether depressive symptoms changed from pre- to posttreatment. Pretreatment Zung score did not predict outcome on the MAL Arm Use scale, ΔR2 (1, 30) = 0.004, p = .19, after controlling for pretreatment MAL scores. Additionally, participants had a small but statistically significant decrease in Zung score, t(39) = 3.0, p = .005, mean change = -3.6. These results suggest that depressive symptoms do not significantly limit motor recovery in patients treated with CIMT for chronic poststroke hemiparesis. Additionally, treatment with CIMT may improve depressive symptoms. (PsycINFO Database Record

Trends in Head and Neck Cancer Post-Treatment Rehabilitation

Little is known about patterns of surveillance in head and neck cancer (HNC) survivorship care. Using a national database, we aimed to evaluate trends in post-treatment utilization of rehabilitation services for HNC survivors. Using Surveillance, Epidemiology and End Results (SEER)-Medicare data for HNC patients treated between 2002 and 2011 to evaluate post-treatment rehabilitation use. A total of 16,194 eligible patients underwent treatment for HNC between January 1, 2002, and December 31, 2011. During the first 2 post-treatment years, 25.7% (N=4,155) of patients received any rehabilitation services, while 20.6% (N=3,328) specifically received speech pathology services. The use of rehabilitation services increased in the second post-treatment year over the first (3.6% versus 3.1%, respectively, p<0.02). Patients who underwent multimodality therapy were more likely to utilize speech pathology services than those who received single modality therapy (28.1% versus 55.9%, P < 0.0001). Multivariate analysis demonstrated that speech pathology utilization increased on average 7% for each increasing year of diagnosis (OR=1.07, 95% CI 1.05-1.09); this was most prominent for patients who received radiation as part of their therapy (OR 2.3, 95% CI 2.02-2.7). We evaluated national trends of post-treatment use of rehabilitation services. The use of services increased in the second post-treatment year, indicating an increasing need for long-term treatment effects. The frequency of post-treatment speech pathology services increased annually over the study period; further study is needed to identify benefits of this increased resource utilization.

Educational and rehabilitation service utilization in adolescents born preterm or with a congenital heart defect and at high risk for disability.

This historical cohort study describes the use of educational and rehabilitation services in adolescents born preterm or with a congenital heart defect (CHD). Parents of 76 young people (mean age 15y 8mo [SD 1y 8mo]) with CHD and 125 born ≤29 weeks gestational age (mean age 16y [SD 2y 5mo]) completed a demographics questionnaire including educational and rehabilitation resource utilization within the previous 6 months. Rehabilitation services included occupational therapy, physical therapy, speech language pathology, psychology. Developmental (Leiter Brief IQ, Movement-ABC, Strengths and Difficulties Questionnaire) and functional (Vineland) status of the young people was assessed. Pearson χ2 tests were used to perform simple pairwise comparisons of categorical outcomes across the two groups (CHD, preterm). Univariate logistic regression was used to examine predictors of service utilization. Developmental profiles of the two groups (CHD/preterm) were similar (29.9%/30% IQ<80; 43.5%/50.0% motor difficulties; 23.7%/22.9% behavior problems). One-third received educational supports or attended segregated schools. Only 16% (preterm) and 26.7% (CHD) were receiving rehabilitation services. Services were provided predominantly in the school setting, typically weekly. Few received occupational therapy or physical therapy (1.3-7.6%) despite functional limitations. Leiter Brief IQ<70 was associated with receiving educational supports (CHD: OR 5.53, 95% CI 1.29-23.68; preterm: OR 14.63, 3.10-69.08) and rehabilitation services (CHD: OR 4.46, 1.06-18.88; preterm: OR 5.11, 1.41-18.49). Young people with motor deficits were more likely to require educational (CHD: OR 5.72, 1.99-16.42; preterm: OR 3.11, 1.43-6.77) and rehabilitation services (preterm: OR 3.97, 1.21-13.03). Although young people with impairments were more likely to receive educational and rehabilitation services, many may not be adequately supported, particularly by rehabilitation specialists. Rehabilitation services at this important transition phase could be beneficial in optimizing adaptive functioning in the home, school, and community.