Highlights
- •Younger people (16 to 25 years) admitted to rehabilitation with a more severe disability profile
- •Younger people were more likely to make improvements during rehabilitation
- •Accessing existing sources of data is a useful method for filling in gaps about outcomes for rare diseases.
ABSTRACT
Background
Recent evidence has suggested an existence of a MS prodome, indicating that symptoms
of neurodegeneration were present before the first clinical event. These early signs
of MS are usually not recognized as a symptom of MS and some young adults with MS
are very likely to have had these symptoms in their childhood or adolescence. It is
thus of interest to examine the differences in disability profiles of young people
with MS. This study focused on young people with MS with severe enough disability
as to need rehabilitation services. The most likely reason for this need is poor recovery
from a relapse.
Objectives
The purpose of the study is to characterize and compare the functional profiles (as
reflected by Functional Independence Measure scores) of people with MS admitted to
in-patient rehabilitation in Canada across two age groups (younger than 25 and 26
to 35 years old) with specific aims to estimate the extent to which these profiles
change over time; and to identify the proportions of people who made a reliable change.
Methods
Data from the National Rehabilitation Reporting System (NRS) in Canada was analyzed.
The dataset contained information of 457 people with MS aged 16 to 35 who were admitted
to inpatient rehabilitation. Scores on the Functional Independence Measure at admission
and discharge were analyzed using latent class analysis. Change in FIM was estimated
using reliable change index. Probability of making a reliable change across the different
classes, age and sex was estimated using logistic regression.
Results
There were four functional classes at admission and three classes at discharge. The
four functional classes at admission were: A). Minimal assistance/Supervision in walking,
B). Assistance in Activities of Daily Living (ADL)/Mobility, C). Assistance/dependent
in ADL/Mobility, and D). Dependent in ADL and mobility. At admission, 19.7% of patients
belonged to the best class, but at discharge, 66.8% of people belonged to the best
class, indicating that 45% of the patients improved. Across the two age groups, disability
profiles differed at admission and discharge. People who are 25 years and younger
were more likely to belong to the lower functioning profiles classes (Class C and
D) compared to the older group who were more likely to belong to Class B and C, indicating
that younger people were more impaired at admission. The probability of making reliable
change was also different between the latent classes. People in the lowest two classes
at admission, were more likely to make reliable change (OR=10.9, OR=7.2).
Conclusions
The results of this study suggest that younger people were admitted with a more severe
disability profile when compared to a slightly older group but were more likely to
make improvements during rehabilitation. The functional profiles in MS differed across
sex and age, signaling a need to tailor rehabilitation interventions across the functional
profiles, age and sex. Accessing existing sources of data is a useful method for filling
in gaps about outcomes for populations with rare diseases.
Keywords
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Article info
Publication history
Published online: July 22, 2020
Accepted:
July 22,
2020
Received in revised form:
June 24,
2020
Received:
March 25,
2020
Identification
Copyright
© 2020 Elsevier B.V. All rights reserved.
