[State of practice: risks of hospitalization and death related to COVID-19 in people with physical disabilities using rehabilitation services]

Ghandour EK, Kaboré JL
Record ID 32018002648
Original Title: État des pratiques - Risques d’hospitalisation et de décès en lien avec la COVID-19 chez les usagers des services de réadaptation présentant une déficience physique
Authors' objectives: Disability takes many forms in the literature, including physical disabilities (motor impairment (MI), hearing impairment (HI) and visual impairment (VI)), traumatic brain injuries, intellectual disabilities and developmental disorders. In Quebec, physical disability (PD) is defined as a condition which results in or is most likely to result in significant and persistent disabilities (including episodic disabilities) related to hearing, vision, language or motor activities and which reduces or is likely to reduce the performance of current activities or social roles. The prevalence of disability for Quebecers aged 15 and over was 16% in 2017. People with physical disabilities often present multiple functional limitations, chronic health problems1 and other individual factors, such as residing in communal living settings, having multiple contacts with caregivers or experiencing communication difficulties. In the scientific literature published internationally, these factors have been associated with an increased risk of infection, hospitalization and complications from COVID-19 infection. To determine whether people presenting a PD were more at risk of hospitalization and death from COVID-19 than the general population in Quebec, an analysis was carried out using paired data from the clinical administrative databases of the Régie de l'assurance maladie du Québec (RAMQ), the ministère de la Santé et des Services sociaux (MSSS) and the “COVID cohort” established at INESSS in response to the pandemic.
Authors' results and conclusions: RESULTS: (#1. Cohort Characteristics): The PD cohort was made up of people who received specialized or highly specialized services from the Physical Disability service program2 in the last five years (active users). • This cohort consisted of just over 164,000 individuals. • The analysis includes all cases of infection with the SARS-CoV-2 virus between March 1, 2020 (start of the first wave) and December 4, 2021 (end of the fourth wave). • Data for the fifth wave was not considered in the analysis because, as of the onset of this wave, the health and social services system stopped providing accurate counts of the number of cases of infection.(#2. Hospitalization): After adjustment,3 COVID cases in the PD cohort were at higher risk of being hospitalized compared to COVID cases in the rest of the population. However, this risk was different depending on the type of impairment: – COVID cases with a motor impairment (MI) had a 65% higher risk; – those with a visual impairment (VI) had a 10% higher risk; – those with a hearing impairment (HI) presented no greater risk of hospitalization. (#3: Death): After adjustment, there was no difference in the risk of death for COVID cases in the PD cohort compared to COVID cases in the rest of the population. • There was also no difference in the risk of death for COVID cases, regardless of impairment type, compared to the rest of the population. CONCLUSION: The results of this analysis indicate that people in the PD cohort are not at greater risk of death than the general population; they are, however, at greater risk of being hospitalized. Personal and environmental factors can contribute to this situation. It can be explained in particular by the higher rates of comorbidities as well as by the physiological changes which accompany certain physical conditions and which increase vulnerability to respiratory diseases. The literature also suggests other possible reasons to explain this greater risk of hospitalization. One such reason relates to the difficulty experienced by individuals with a PD in communicating their needs or understanding information that is imparted to them orally when wearing a mask. Another reason is the restricted access to certain rehabilitation or home support services. These results can support the planning of future measures in the context of a pandemic. It seems important to adapt preventive measures and the provision of care and services to suit the specific needs of people with a PD. It would be beneficial to ensure that accommodations are available for individuals who need a third party in order to communicate. Training clinicians on the needs and rights of people with a PD may also be helpful. Finally, higher unplanned readmission rates, as documented in the scientific literature, underscore the importance of implementing a patient-centred discharge process to help patients organize a safe return to their living environment. [Brown et al., 2022; Kavanagh et al., 2021; Morrow et al., 2021].
Authors' methods: A caveat is necessary for the interpretation of the data. Physical disability is not a diagnosis, and no specific code is available in the clinical administrative databases. To create the cohort, it was therefore necessary to use the database of the Information System for Persons with Disabilities (SIPAD), which records the services offered by rehabilitation centres in Quebec. This database is most likely made up of people who are more heavily affected than the general population living with a PD. The results of the analyses carried out as part of this review of practices do not therefore apply to all Quebecers with a PD and cannot be generalized to this entire population.
Project Status: Completed
Year Published: 2022
English language abstract: An English language summary is available
Publication Type: Other
Country: Canada
Province: Quebec
MeSH Terms
  • COVID-19
  • Coronavirus Infections
  • SARS-CoV-2
  • Rehabilitation
  • Risk Factors
  • Disabled Persons
  • Risk Assessment
Organisation Name: Institut national d'excellence en sante et en services sociaux
Contact Address: L'Institut national d'excellence en sante et en services sociaux (INESSS) , 2021, avenue Union, bureau 10.083, Montreal, Quebec, Canada, H3A 2S9;Tel: 1+514-873-2563, Fax: 1+514-873-1369
Contact Name: demande@inesss.qc.ca
Contact Email: demande@inesss.qc.ca
Copyright: Gouvernement du Québec
This is a bibliographic record of a published health technology assessment from a member of INAHTA or other HTA producer. No evaluation of the quality of this assessment has been made for the HTA database.