Access to hospital-based rehabilitation for people with multiple sclerosis in France: A nationwide study (2017-2023).

Abstract

Background: Multiple sclerosis (MS) is frequently associated with progressive motor and functional impairment that requires multidisciplinary rehabilitation. In France, coordinated inpatient and outpatient rehabilitation is delivered at hospital-based facilities. However, national population-based data on the access to these services by people with MS (PwMS) are scarce.

Objective: To determine the access to hospital-based rehabilitation by PwMS in France from 2017 to 2023, and identify individual, clinical and contextual factors that influence its utilization.

Methods: This nationwide retrospective study (2017-2023) used data from the French National Health Data System. The association of patient characteristics, disease severity, and territorial healthcare indicators with rehabilitation access was assessed with multilevel analyses. Regional disparities and patient flows were described using spatial analyses.

Results: Among the 130,015 PwMS (72.1% women, mean age [SD]: 54.0 [14.5] years), 12,325 (9.5%) had at least one hospital-based rehabilitation stay in 2023 (22,160 stays: 32.2% inpatient and 67.8% outpatient stays). Fewer women had hospital-based rehabilitation (8.6% vs. 11.8% of men). Physiotherapy use was higher among patients with than without a hospital-based rehabilitation stay (76.5% vs. 35.9%). Rehabilitation access was strongly associated with disease severity, use of walking aids, and treatment with fampridine. Access was also strongly influenced by service availability, particularly the physical and rehabilitation medicine (PRM) doctors' density, resulting in marked geographical disparities and substantial inter-departmental patient flows. Outpatient care was mostly delivered locally, whereas inpatient care was concentrated in a limited number of centers, generating substantial inter-departmental patient flows.

Conclusions: Access to hospital-based rehabilitation for PwMS in France remains limited and uneven, despite the expected substantial needs. Utilization is primarily driven by disease severity and availability of specialized professionals, particularly PRM, and also by territorial and sex-related disparities. These findings highlight a persistent gap between recommendations and real-world practice, underscoring the need to strengthen rehabilitation pathways, improve service availability, and integrate rehabilitation earlier in the MS care pathway.