Complexity, Multi-Morbidity, Polypharmacy and Disability in People With Multiple Sclerosis Seen by A Canadian Specialist in Physical Medicine and Rehabilitation. A Retrospective Chart Review

OBJECTIVE: To describe the characteristics and needs of people with multiple sclerosis (PwMS) seen by specialist physical medicine and rehabilitation (PM&R). DESIGN: A retrospective chart review of all PwMS seen by physiatry (n=477) at the largest Canadian MS clinic between December 2021 and December 2023 was conducted. Demographic characteristics, symptoms, comorbidities, medications, health service use, MRI findings, and physical examination findings were collected. Log-binomial regressions were conducted to examine the association between symptoms and health service. RESULTS: Participants had a high number of symptoms (M=6.55, SD=2.22), with most reporting fatigue (78.6%), spasticity (78.2%), pain (74.4%), bladder dysfunction (75.7%), and emotional symptoms (59.5%). Cognitive (PR=1.23, 95% CI=1.12-1.36), emotional (PR=1.13, 95% CI 1.02-1.26), and swallowing (PR=1.14, 95% CI=1.02-1.28) symptoms were significantly associated with multiple health services use. Comorbidity count was high (Mdn=3, IQR=1-4) with the most common being depression (23.7%), hypertension (22.2%), anxiety (13.2%), hyperlipidemia (13.2%), and osteoporosis (10.9%). PwMS had high levels of polypharmacy, with an average of 7.3 (SD=4.1) medications used. CONCLUSION: PwMS seen by specialty PM&R are clinically complex, with high symptom and comorbidity burden, polypharmacy, and disability. Physiatrists working with PwMS should be trained to manage common symptoms, comorbidities, and high levels of polypharmacy for optimal care.