Admission and discharge profiles of people with MS accessing in-patient rehabilitation in Canada

Abstract

AbstractBackgroundRehabilitation is the mainstay of management for people with disabilities of neurological origin to maximize function and reduce disability. Access to in-patient rehabilitation is usually reserved for people after crises or those who are discharged from acute care such as in stroke or trauma. Access to people with Multiple Sclerosis (MS) differs across countries and unknown for Canada. With the progression of MS, quality of life (QOL) becomes more closely coupled with independence and hence timely access to rehabilitation is important. The objectives of this paper are (i) to characterize the disability profiles of people with MS admitted to in-patient rehabilitation in Canada; and (ii) to estimate the extent to which disability profiles differ from admission to discharge.MethodsA longitudinal study of a rehabilitation admission-to-discharge cohort of 3500 people with MS was conducting using latent class analysis on the five Functional Independence Measure (FIM) subscales for Self-care, Transfers, Locomotion, Bladder/Bowel, and Cognition. The extent to which age, sex, and calendar time was associated with latent class membership, at both admission and discharge, was estimated using ordinal logistic regression, and proportional odds model was calculated for each age and sex.ResultsA five-class model fit the data at admission and a four-class model fit the data at discharge determined using likelihood ratio G2, Akaike’s Information Criterion, and Bayesian Information Criterion.ConclusionAt admission, the disability profiles showed a hierarchical progression across the FIM subscales. The least disabled profile was characterized by locomotion dependency only; the most disabled profile was characterized by dependencies in all subscales except cognition. At discharge, the least disabled class, representing 28% of discharges, was characterized by no dependencies; the most disabled class remained with dependencies (23%) in all areas. The study highlights the importance of reserving scarce rehabilitation services to those with more disability.