Rehabilitation Underutilization: Using a Model of Rheumatoid Arthritis to Illustrate Unmet Needs.

Objective: To quantify the proportion of individuals who have underutilized rehabilitation for rheumatoid arthritis (RA) and examine the associations of demographic and clinical characteristics with rehabilitation underutilization. Design: Cross-sectional. Setting: Online survey. Participants: Adults with RA (N=309) who received care at an academic medical center rheumatology clinic from January 1, 2020 to December 31, 2021. Of 1506 patients identified from electronic medical records who met inclusion criteria, 659 were contacted, 354 enrolled in the study, and 309 completed the survey (age 56.5±14.1y, 82% women). Interventions: Not applicable. Main Outcome Measures: The primary outcome was rehabilitation underutilization, which was defined as reporting moderate-severe functional limitation (Patient-Reported Outcome Measure Information System Physical Function -10a score <40) and never using rehabilitation services related to RA (self-reported use yes vs. no). The exposure variables were race and ethnicity, gender identity, health insurance, financial status, education status, work status, and body mass index. Results: Of 309 adults with RA who participated, 47% reported moderate-severe functional limitation, 63% never used rehabilitation services related to RA, and 25% had underutilized rehabilitation. The following characteristics were strongly associated (adjusted OR range 2.8-15.8) with rehabilitation underutilization: Medicaid + Medicare, Medicaid, Medicare, no health insurance, lower financial status, lower education, disabled work status, obesity, and major comorbidity. Conclusions: One in 4 adults with RA underutilized rehabilitation. There is a clear unmet need for rehabilitation, particularly in adults with lower socioeconomic status and groups with greater functional needs. Future work should develop strategies to facilitate rehabilitation use for adults with RA who need it.