Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Hirschengraben 84, 8001 Zurich, Switzerland; Department of Health Sciences and Technology, ETH Zurich, Zürich, Switzerland.
Institut für Physiotherapieforschung, Lindenweg 48, 2503 Biel, Switzerland.
Mult Scler Relat Disord. 2021 Feb;48:102710. doi: 10.1016/j.msard.2020.102710. Epub 2020 Dec 23.
Physiotherapy may alleviate many multiple sclerosis (MS) symptoms, yet very little is known about physiotherapy accessibility and possible barriers in persons with MS (pwMS). We therefore aimed to elucidate physiotherapy use and possible access-barriers using data from 1493 pwMS from the Swiss Multiple Sclerosis Registry (SMSR), a patient-centered, longitudinal, observational MS study.
We used data of the SMSR to investigate the question at hand in a multivariable logistic regression model with regularly receiving physiotherapy (yes/no) as the outcome. Potential explanatory variables were investigated following an AIC-driven model selection approach and consisted of a priori specified socio-demographic variables, health status, and personal or social mobility variables. As a last step, the impact of physiotherapist supply on regular use was assessed in the final model. Missing data were handled by multiple imputation (main analysis), and complete case sensitivity analyses were performed.
The main analysis included 1493 participants. In the multivariable logistic regression, positive associations were found between the use of physiotherapy and the following variables: having a primary-progressive MS (Odds Ratio (OR) [95% Confidence Intervals] 1.97 [1.18; 3.29]), being more severely impaired (EDSS 4-6.5 OR 1.84 [1.16; 2.91]), higher number of current symptoms (1 OR 3.31 [1.63; 6.74], 2-3 OR 3.43 [1.8; 6.53], 4-5 OR 4.44 [2.28; 8.66], 6-7 OR 4.06 [1.90; 8.70], 8-9 OR 3.87 [1.71; 8.75], being on disability pension (OR 1.75 [1.24; 2.46], or having applied for it OR 2.25 [1.31; 3.85]), having gait problems (OR 1.58 [1.11; 2.23]), having been in a rehabilitation clinic in the past 12 months (OR 4.43 [2.17; 9.03]), and currently being on disease-modifying treatment (OR 1.61 [1.12; 2.31]). Negative associations were found for a higher quality of life (OR 0.92 [0.85; 0.98]), working more than 80% (OR 0.47 [0.30; 0.75]) and being from the French language region (OR 0.66 [0.47; 0.94]). No association between physiotherapist supply and regular physiotherapy use was detected.
In a large, Swiss-based MS population, little evidence for socio-demographic barriers to physical therapy was found. Physiotherapy uptake was higher among pwMS with more impairments, lower health-related quality of life, or who have been discharged recently from inpatient rehabilitation. The uptake differences by language region warrant further investigations.
物理疗法可能缓解多发性硬化症（MS）的许多症状，但对于 MS 患者（pwMS）的物理治疗可及性和可能存在的障碍知之甚少。因此，我们旨在使用来自瑞士多发性硬化症登记处（SMSR）的 1493 名 pwMS 的数据阐明物理治疗的使用情况和可能的使用障碍，该登记处是一项以患者为中心、纵向、观察性 MS 研究。
我们使用 SMSR 的数据，在多变量逻辑回归模型中，使用定期接受物理治疗（是/否）作为结果，研究手头的问题。潜在的解释变量按照 AIC 驱动的模型选择方法进行调查，包括预先指定的社会人口统计学变量、健康状况以及个人或社会流动性变量。作为最后一步，在最终模型中评估物理治疗师供应对定期使用的影响。使用多重插补（主要分析）处理缺失数据，并进行完整案例敏感性分析。
主要分析包括 1493 名参与者。在多变量逻辑回归中，与物理治疗使用相关的积极关联包括：原发性进行性 MS（优势比（OR）[95%置信区间]1.97 [1.18; 3.29]）、严重受损（EDSS 4-6.5 OR 1.84 [1.16; 2.91]）、当前症状更多（1 OR 3.31 [1.63; 6.74]，2-3 OR 3.43 [1.8; 6.53]，4-5 OR 4.44 [2.28; 8.66]，6-7 OR 4.06 [1.90; 8.70]，8-9 OR 3.87 [1.71; 8.75]）、残疾养恤金（OR 1.75 [1.24; 2.46]）或申请残疾养恤金（OR 2.25 [1.31; 3.85]）、有步态问题（OR 1.58 [1.11; 2.23]）、过去 12 个月在康复诊所（OR 4.43 [2.17; 9.03]）、目前正在接受疾病修正治疗（OR 1.61 [1.12; 2.31]）。发现与更高的生活质量（OR 0.92 [0.85; 0.98]）、工作超过 80%（OR 0.47 [0.30; 0.75]）和来自法语区（OR 0.66 [0.47; 0.94]）呈负相关。未发现物理治疗师供应与定期物理治疗使用之间存在关联。
在一个大型的瑞士 MS 人群中，发现物理治疗的社会人口统计学障碍证据很少。在 EDSS 评分较高、健康相关生活质量较低或最近从住院康复中出院的 pwMS 中，物理治疗的使用率较高。语言区域的使用率差异值得进一步调查。
