Were unmet rehabilitation needs associated with health deterioration during COVID-19? A cross-sectional study of Canadians with disabilities.
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BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic disrupted rehabilitation services, disproportionately affecting individuals with long-term conditions or disabilities. However, the health impacts of unmet rehabilitation needs in this population remain underexplored. OBJECTIVE: To determine the association between unmet rehabilitation needs and self-perceived health deterioration among Canadians with long-term conditions or disabilities during the first wave of COVID-19. METHODS: We analysed a national crowdsourced cross-sectional survey conducted by Statistics Canada (June 23-July 6, 2020). Participants included 13,483 Canadians aged 15 years and older with reported long-term conditions or disabilities. Unmet rehabilitation needs (independent variable) were defined as requiring but not receiving physiotherapy/massage therapy/chiropractic services, speech or occupational therapy, counselling or support groups due to the pandemic. Health deterioration (dependent variable) was self-reported as "much worse" or "somewhat worse" compared to pre-pandemic levels. We computed adjusted prevalence ratios (aPR) and 95 % confidence intervals (CI) using modified Poisson regression, controlling for sociodemographic factors and other unmet healthcare needs, including unmet medical attention for COVID-19. Analyses were stratified by age group, gender, and residence location. RESULTS: Overall, 47 % of participants reported health deterioration during the early stages of the pandemic. Among those with health deterioration, 59 % reported unmet rehabilitation needs due to the pandemic. Those with unmet rehabilitation needs were 33 % more likely to report health deterioration (adjusted PR = 1.33, 95 % CI 1.27-1.40), regardless of sociodemographic characteristics and other unmet healthcare needs. The associations were consistent across age groups, gender, and residential location. CONCLUSIONS: In a sample of Canadians with long-term conditions or disabilities, unmet rehabilitation needs were associated with self-perceived health deterioration. Addressing these unmet needs is crucial for improving health outcomes and quality of life during public health emergencies. In the post-pandemic era, improved access and better integration of rehabilitation services within the broader healthcare system remain essential to support well-being and restore functioning in this population. DATABASE REGISTRATION: Not applicable. This study involves secondary analysis of a publicly available, de-identified national dataset collected by Statistics Canada.
