Functioning Profiles of Young People with MS in Inpatient Rehabilitation: Data from the National Rehabilitation Reporting System in Canada

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.