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Seoul National University College of Medicine, Seoul National University Hospital, Department of Rehabilitation Medicine1, Graduate School, University of Ulsan, Interdisciplinary Program of Medical & Biological Engineering2, School of Electrical Engineering, University of Ulsan, Biomedical Engineering3 |
Background: Recent evidence and guidelines recommend appropriate rehabilitation from the beginning of diagnosis in patients with Parkinson disease (PD). Although rehabilitation for PD may not be adequately provided in Korea, there is no information about rehabilitation therapy utilization in these patients.
Objectives: The purpose of this study is to investigate the utilization of rehabilitation therapy in patients with PD and to analyze the patients’ characteristics associated with it.
Materials and Methods: We used the National Health Insurance Service-National Sample Cohort (NHIS-NSC) for 2002-2015, including total 1,000,000 sampled from a target population of 48,222,537 individuals in the 2006 NHI Database. We identified cases with Parkinson disease using the registration code for PD (V124), from the registration program for cancer and 62 rare intractable diseases initiated in 2004, in every 3 years. Therefore, these prevalent cases were divided into 4 groups according to the period: 2004-2006, 2007-2009, 2010-2012, and 2013-2015. Among them, we excluded individuals who had diagnostic clams for other parkinsonisms (G21, G22, and G23) and who had no prescription of antiparkinson medication. We assessed utilization of rehabilitation therapies by identifying claims having procedure codes for physical therapy (PT), occupational therapy (OT), and swallowing therapy (ST) in each 3-year study period. Demographic data, comorbidities which might require rehabilitation, and prescribed antiparkinson medications were also identified. The effect of patients’ characteristics on rehabilitation therapy utilization was investigated multivariable logistic regression analysis in the period of 2013-2015.
Results: PD patients who met the inclusion and exclusion criteria were identified as 384 in 2004, 855 in 2007, 1,023 in 2010, and 1,222 in 2013 (Table 1). The numbers of physiatrist visits were 221 (0.58 per person) in 2004-2006, 824 (0.96 per person) in 2007-2009, 2013 (1.97 per person) in 2010-2012, and 3550 (2.91 per person) in 2013-2015. Among these patients, 35-40% had claims for PT, 16-19% had claims for OT, and 4-6% had claims for ST without remarkable differences between the study periods (Fig. 1). The number of claims for each rehabilitation therapies is presented in Table 2. Female sex, age older than 70, high income, severe disability, and high levodopa equivalent dose were significantly associated with rehabilitation therapy utilization in patients with PD.
Conclusion: Although the number of physiatrist visits increased about 5 times over 10 years, the number of claims for PT, OT, and ST showed no change in patients with PD. According to recent evidence and guidelines, rehabilitation therapy utilization may be suboptimal in Korea. The associated patients’ characteristics should be considered to provide adequate rehabilitation in these patients. |
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Table 1. Characteristics of patients with PD in each 3-year study period.
Table 2. Number of claims for each rehabilitation therapies. *Simple therapeutic exercise (MM101) was excluded in this study because this code serves only 10 minutes of exercise, which is too short for the rehabilitation purpose, and widely used in primary health care service for musculoskeletal problems.
Fig. 1. The percentage of patients who had claims for PT, OT, and ST in each study period.
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