Health Policy and Systems
Jong Moon Kim, MD
Associate Professor
CHA university
seoul, Seoul-t'ukpyolsi, Republic of Korea
Daniel Youngsuk Kim, MS
medical student
CHA University
Seongnam, Kyonggi-do, Republic of Korea
Keeyeon Ki-cheon Park, PhD
professor
Kongju National University
Kongju, Ch'ungch'ong-namdo, Republic of Korea
Hyunah Kim, PhD
professor
Korea Aerospace University
Goyang-si, Kyonggi-do, Republic of Korea
Mi Ri Suh, MD
professor
CHA university
Seongnam-si, Kyonggi-do, Republic of Korea
The COVID-19 pandemic disrupted rehabilitation services requiring in-person care. How outpatient rehabilitation use changed among patients with central nervous system (CNS) disorders during pandemic surges remains unclear.
Design: We conducted a retrospective cohort study (Jan 2018–Aug 2023) using a hospital clinical data warehouse. Outpatient rehabilitation encounters for cerebral palsy, malignant brain tumor, Parkinson’s disease, stroke, spinal cord injury, and traumatic brain injury were analyzed across physical, occupational, speech, and manual therapy. Daily COVID-19 case counts were obtained from the Korea Disease Control and Prevention Agency. Six pandemic phases were defined. Associations between case counts and utilization were estimated using Prais–Winsten regression with AR(1).
Results:
Overall outpatient rehabilitation utilization decreased by approximately 4% for every 100,000 additional COVID-19 cases. Declines were most pronounced in Phase 2 (≈15% reduction) and Phase 3 (≈11%), with attenuation in later phases. Physical (−4.6%) and occupational therapy (−5.6%) consistently decreased, while speech and manual therapy were largely unaffected. Subgroup analyses showed significant reductions for Parkinson’s disease (−10%), traumatic brain injury (−7%), and cerebral palsy (−5%), but not for stroke, spinal cord injury, or malignant brain tumor. Age-stratified analyses revealed declines in children (−4% to −6%) and older adults (−7% to −9%), whereas adults aged 20–49 years showed no significant changes.
Conclusion: COVID-19 surges were associated with substantial declines in outpatient rehabilitation use among patients with CNS disorders, particularly in early phases and in vulnerable age groups. Rehabilitation for stroke and spinal cord injury remained relatively preserved. These findings highlight the importance of resilient care models—including tele-rehabilitation—to maintain continuity during future outbreaks.
