Turner-Stokes Lynne, Harding Richard, Yu Peihan, Dzingina Mendwas, Gao Wei
Department of Palliative Care, Policy and Rehabilitation, Faculty of Nursing Midwifery and Palliative Care, King's College London, UK.
Mult Scler J Exp Transl Clin. 2020 Mar 16;6(1):2055217320912789. doi: 10.1177/2055217320912789. eCollection 2020 Jan-Mar.
Rehabilitation is effective for multiple sclerosis, but is it value for money?
To evaluate functional outcomes, care needs and cost-efficiency of specialist inpatient rehabilitation for adults with multiple sclerosis (MS).
A multicentre cohort study of prospectively collected clinical data from the UK Rehabilitation Outcomes Collaborative national clinical database. Data included all adults with MS ( = 1007) admitted for specialist inpatient (Level 1 or 2) rehabilitation in England, 2010-2018.
Dependency/care needs: Northwick Park Dependency Scale/Care Needs Assessment, Functional independence: UK Functional Assessment Measure (UK FIM+FAM). Cost-efficiency. Patients were analysed in three dependency groups (High/Medium/Low).
All groups showed significant reduction in dependency between admission and discharge on all measures (paired -tests: < 0.001). Mean reduction in care costs/week was greatest in the most dependent patients: High: £519 (95% CI: 447-597), Medium: £148 (76-217), Low: £36 (12-83). Despite longer stays, time taken to offset the cost of rehabilitation was shortest in the most dependent patients: High: 12.9 (12.0-14.1) months; Medium: 29.3 (21.3-51.8); Low: 76.8 (0-36.1). Item-level changes corresponded with clinical experience.
Specialist rehabilitation provided good value for money in patients with MS, yielding improved outcomes and substantial savings in ongoing care costs, especially in high-dependency patients.
康复治疗对多发性硬化症有效，但它是否物有所值？
评估成年多发性硬化症（MS）患者专科住院康复治疗的功能结局、护理需求和成本效益。
一项多中心队列研究，前瞻性收集来自英国康复结局协作组织国家临床数据库的临床数据。数据包括2010年至2018年在英格兰因专科住院（1级或2级）康复治疗而入院的所有成年MS患者（n = 1007）。
依赖性/护理需求：诺斯威克公园依赖性量表/护理需求评估，功能独立性：英国功能评估量表（UK FIM+FAM）。成本效益。患者被分为三个依赖性组（高/中/低）进行分析。
所有组在所有指标上入院时和出院时的依赖性均显著降低（配对t检验：p < 0.001）。护理成本/周的平均降低幅度在依赖性最强的患者中最大：高：519英镑（95%CI：447 - 597），中：148英镑（76 - 217），低：36英镑（12 - 83）。尽管住院时间较长，但抵消康复治疗成本所需时间在依赖性最强的患者中最短：高：12.9（12.0 - 14.1）个月；中：29.3（21.3 - 51.8）；低：76.8（0 - 36.1）。项目层面的变化与临床经验相符。
专科康复治疗对MS患者具有良好的成本效益，可改善结局并大幅节省持续护理成本，尤其是在高依赖性患者中。
