评估急性后康复服务对多发性硬化症患者医疗效果的影响。

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

机构信息

Department of Health Services, Policy, and Practice and Center for Gerontology and Health Care Research, Brown University School of Public Health, Box G-S121-6, 121 South Main Street, Providence, RI, United States.

New York Medical College, Valhalla, NY, United States.

出版信息

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

DOI:10.1016/j.msard.2019.03.003

PMID:30852305

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.

摘要

背景

在熟练护理机构（SNF）中提供的康复服务对一个特别脆弱、残疾的亚组，即多发性硬化症患者（PwMS）的影响尚不清楚。

目的

本研究的目的是：（1）描述多发性硬化症患者在 SNF 中使用康复服务的情况，以及（2）检查物理治疗和职业治疗（PT/OT）的使用与（a）多发性硬化症患者成功出院和（b）功能改善之间的关系。

方法

我们从 2008 年 1 月至 2012 年 9 月期间在医院新入院的 SNF 中的多发性硬化症患者中进行了回顾性选择。使用最低数据集（MDS），我们检查了接受 PT/OT 的情况，并根据每周的中位数小时数将接受情况分为高和低强度 PT/OT。我们使用倾向匹配的逻辑回归评估了高与低 PT/OT 与成功出院到社区和功能改善的关系。

结果

在研究期间，共有 26412 名多发性硬化症患者在 MDS 中有有效的 OT/PT 值，其中 24410 名（92.4%）在 SNF 中使用了一段时间的 PT/OT。PT/OT 的中位使用时间为 9.7 小时/周。接受康复服务的患者认知和功能障碍较轻。总体而言，在目标 2a（n=8204/组）的两个倾向匹配队列中，有三分之二（67.3%）成功出院到社区；在目标 2b（n=6803/组）的三分之一（33.6%）匹配队列中，功能有所改善。较高的 PT/OT 治疗与成功出院相关（优势比[OR]1.20；95%置信区间[CI]1.12-1.28）和功能改善（OR 1.21；95% CI 1.13-1.30）。