The Association between Education and Rehabilitation Outcomes: a Population Retrospective Observational Study

Objectives: Retrospective observational study aiming at testing whether different education levels in older adults are associated with the rehabilitation outcome. Study design: The study planned to cover all patients of over 65 rehabilitated from 2015 to 2017 at Golgi-Redaelli, a large government-funded rehabilitation Institute in Northern Italy comprising of three centers. Different administrative datasets were linked to investigate the factors associated with the functional outcome. The cohort resulted in 2,486 older adults for whom information on education and rehabilitation outcome was available. Main outcome measures: Rehabilitation outcome was measured with the Barthel Index testing the ability in basic activities of daily living and the Tinetti Performance Oriented Mobility Assessment measuring stability and walking. Multiple linear and logistic regression models were run controlling for rehabilitation setting and center of care, age, gender, cognitive functioning and comorbidity. Results: Education resulted negatively associated with functional recovery. Patients with at least 8 years of education improved 2.24 point less in Barthel Index (out of100) and 0.70 points less in Tinetti PerformanceOriented Mobility Assessment (out of 28) than the less educated patients. Results confirmed the importance of cognitive functioning in predicting rehabilitation outcome in older patients. Conclusions: Different mechanisms can explain an unexpected negative association between education and re-habilitation outcome, when possible inequalities in access to care are controlled for by study design (the cohort was admitted to a NHS-funded institute). Additional studies are needed to confirm our results and to test more specific hypotheses about the degree of effectiveness of rehabilitation across socio-economic groups