Outpatient rehabilitation for chronic neuromuscular diseases.

Cost-conscious outpatient rehabilitation of 210 patients in a neuromuscular disease clinic was examined. The patients followed over a one-year period included: Duchenne Muscular Dystrophy, [50], Charcot-Marie-Tooth [42], Limb-Girdle Dystrophy [37], Spinal Muscular Atrophies [28], "Congenital" Myopathies [12], Friedreich's Ataxia [7], Polymyositis [7] and other related diseases. The 210 patients were profiled by age, sex, family history, and age at onset of symptoms. The rehabilitation of each patient was examined for ancillary service utilization such as pulmonary [11%], orthopedic [10%], and social services consultations [43%], formal occupational [7%] and physical therapy sessions [6%]. Rehabilitation costs were computed for each patient and each disease. "Rehabilitation Costs" included: equipment, laboratory fees, physician fees, building use, medications, travel, and P.T., O.T. and social service charges. Equipment expenditures were the major portion of rehabilitation, determined to be 70% of the annual costs. Because equipment was determined to be the overwhelming "rehabilitation" expense, the types of equipment prescribed for each disease were also defined. Laboratory testing was the next most costly category, resulting in 11% of the overall cost. Physician fees were determined to be only 8% of annual rehabilitation costs. The total mean per capita cost of outpatient rehabilitation was $750 per year, with a range of from $200 per year for Myotonic Dystrophy to $1200 per year for Duchenne Muscular Dystrophy. This study indicates that annual per capita "Rehabilitation Costs" in an outpatient neuromuscular disease clinic are surprisingly inexpensive when one considers the extent of disability in these diseases.