Specific procedure combinations in a rehabilitation setting define severity clusters of older adults with multiple sclerosis: a cohort study

INTRODUCTION: People with multiple sclerosis (PwMS) are ageing and exposed to multiple impairments. We described the use of health care procedures in a physical and rehabilitation medicine setting for PwMS ≥70 years and identified specific participant clusters. METHODS: In this observational cohort study using a local data hub (2012 to March 2024), PwMS were identified with ICD-10 codes (G35). An age filter (≥70) was applied. Medical procedures were systematically coded according to a specific French classification over time, including dates of occurrence, and then extracted and grouped by impairment domains: upper motor neuron syndrome and orthopedic deformities (UMN-OD), respiratory and sleep disorders (RSD), and neurogenic lower urinary tract dysfunction (NLUTD). Clinical data were retrospectively collected from medical files. We conducted descriptive analyses and multiple-component and clustering analyses to identify and characterize the participants' profiles. RESULTS: Among 206 participants aged 75.7 (4.3) years, 62% (128) were women, 19% (39) had died, and MS had evolved for 43.3 (12.4) years. The Expanded Disability Status Scale (EDSS) was 7.5 (6.5-8.5), and the Charlson Comorbidity Index (CCI) was 6 (5-7). A total of 2794 procedures were performed for 187 participants, mainly in NLUTD (1424 for 170), which was associated with RSD (P = 0.001), but not UMN-OD (P = 0.262). Three groups were identified (Group 1 = isolated NLUTD, Group 2 = RSD and intrathecal baclofen procedures, and Group 3 = no in-hospital management). People in Group 2 had more severe comorbidities (P < 0.001) than those in the other two groups (P = 0.016). CONCLUSIONS: In PwMS ≥70 years, the hospital management of MS-related impairments was directly associated with disease severity and overall comorbidities. Participants who were followed only for NLUTD exhibited severity and comorbidity profiles similar to those of participants who did not require hospital procedures. DATA REGISTRATION: Our institutional health data warehouse and all derived extracted databases within the scope of the health team perimeter are approved by the French Data Protection Authority under the No. 1980120.