. Author manuscript; available in PMC: 2022 Jan 1.

Published in final edited form as: Arch Phys Med Rehabil. 2020 Apr 24;102(1):115–131. doi: 10.1016/j.apmr.2020.04.001

Table 1:

Overview of Prevalence, Incidence, Costs, and Activity/Work Limitations of Common Rehabilitation Conditions

Condition	Prevalence	Incidence	Annual Direct Costs (2019 Values in Parentheses)	Annual Indirect Cost (2019 Values in Parentheses)	Annual Total Cost (2019 Values in Parentheses)	Activity Limitations	Work Limitations
Amputation	- 1.6 million (Ziegler-Graham et al¹⁷^**; Ma et al⁵)	General Population - 3.0 per 10,000 non-traumatic LEA (Gregg etal¹⁸^; Narres et al¹⁹) Diabetes-related - 46.2 per 10,000 LEA (Geiss et al²⁰^) - 28.4 per 10,000 LEA (Gregg et al¹⁸^**; Narres et al¹⁹) - 23 per 10,000 LEA above ankle, adults ≥65 (Newhall et al¹⁰⁷) - 45 per 10,000 LEA Medicare population (Margolis et al¹⁰⁸)	- $509,275 ($878,927) total projected lifetime healthcare costs after LEA (MacKenzie et al²¹; Ma et al⁵) - $14,088 ($20,207) mean cost of LEA procedure due to peripheral vascular disease; $22,405 ($32,136) total inpatient cost year prior to amputation + amputation, adults ≥66 (Goodney et al²²) - $17,103 ($24,010) mean cost per inpatient stay for diabetes-related LEA (Yin et al²³)	No new information identified.	Wo new information identified.	- 53.9% non-ambulatory at approximately 1 yr after major LEA (Chopra et al²⁴) - 42.2% and 28.6% of military individuals with traumatic transfemoral and through-knee amputation, respectively, reported being fully disabled and unable to return to duty (Tennent et al²⁵)	- 42% report being unable to work 7 years after traumatic LEA; of those who could work, 20–25% reported work limitations (MacKenzie et al;²⁶ Ma et al⁵)
Back Pain	- 28.6% LBP among community-dwelling adults aged 18–85 (Yang and Haldeman⁴⁴^) - 25.7% LBP among employed adults (Yang et al⁴⁵^) - 13.1% cLBP adults aged 20–69 (Shmagel et al⁴³^**) - 33.9% back pain among community-dwelling adults (BMUS 4th ed.^30†) - 15.0% neck pain among community-dwelling adults (BMUS 4th ed.^30†) - 12.9% prevalence of LBP among all ages; peak prevalence is 25.6% adults aged 80–84 (IHMEGBDTool 2017^32†)	- 67% of men and 61 % of women aged ≥65 (Marshall et al, 2017⁴⁹; Marshall et al, 2016⁵⁰) - 12–14% of all adults have back pain annually; 57.1 million annual patient visits related to back pain, giving a rate of 18.1 persons in 100 seeking care (BMUS 4th ed^30†) - 5,213 per 100,000 incidence of LBP among all ages; peak incidence is 10,425 per 100,000 among adults aged 75–79 (IHMEGBD Tool 2017^32†)	- $315 ($365) billion annual all-cause medical costs from 2012–2014; $9,035 all-cause per patient direct costs; $1,615 ($1,873) per patient incremental costs (BMUS 4th ed.^30†) - $56.5 ($62.3) billion national spine condition-related costs (AHRQ^46†) - $6,892 ($10,104) LBP vs $2,091 ($3,066) for employee matched controls ages 18–64 (Ivanovaet al⁴⁷^**; Tymecka-Woszczerowicz et al⁴⁸) - $8,296 ($11,231) uncomplicated LBP medical cost per case for working adults ≥18 (Shraim et al¹⁰⁹)	- $2,606 ($3,289) LBP-related cost per employed patient (private health insurance) (Ivanova et al⁴⁷^**; Tymecka-Woszczerowicz et al⁴⁸)	- $9,498 ($11,986) LBP-related cost per employed patient on private health insurance (Ivanova, et al⁴⁷^**; Tymecka-Woszczerowicz et al⁴⁸)	- 30% of men and 22% of women ≥65 reported limited activity (Marshall et al, 2017⁴⁹; Marshall et al, 2016;⁵⁰) - 3,180,600 years lived with disability from LBP (Murray et al⁵²) - 347% greater likelihood of difficulty performing ADLS among adults ≥70 with restricting back pain vs matched controls (Markis et al⁵¹)	- 98 days mean length of disability among adults in 12 months after uncomplicated LBP diagnosis (Shraim et al¹⁰⁹) - 12.8% of those with cLBP received disability; those with cLBP were less likely to work (Shmagel et al⁴³) - 8.4 days of medically-related absenteeism on average for working adults (Ivanova et al⁴⁷) - 25.8% (4.9 million) of adults reporting a health condition that precludes work are unable/limited in work due to chronic back or neck problems (BMUS 4th ed.^30†) - Almost 264 million work days lost in one year related to back pain (BMUS 4th ed.^30†) - 385,000 self-reported lost work days due to back pain (BMUS 4th ed.^30†)
Multiple Sclerosis	- 727,344 (Wallin et al⁵³^**) - 150 per 100,000 (Dilokthornsakul et al;⁵⁴) - 0.13% prevalence among all ages; peak prevalence is 0.21 % among adults aged 50–54 (IHME GBD Tool 2017^32†)	- 3 per 100,000 incidence among all ages; 11.7 per 100,000 peak incidence in adults 25–29 (IHME GBD Tool 2017^32†)	- $4.3 ($5.0) billion national inpatient charges w/o professional fees (Chen et al¹¹⁰) - $4.0 ($4.4) billion Medicare Part D expenditure for MS-drugs (Hartung et al¹¹¹) - $51,825-$67,116 ($57,172-$74,041 Jail-cause cost per pt depending on severity of disability (Jones et al⁵⁵^) - $26,520 ($32,655) MS-related costs per pt on average vs $39,948 ($49,189) per pt with malaise/fatigue (Carroll et al¹¹²) - $17,545–41,969 ($21,604–51,678) all-cause, first yr since dx; $8,803–29,355 ($10,839–36,146) MS-related, first yr since dx (Parisé et al⁵⁶^)	- $4,146–9,226 ($4,690–10,437) all-cause; $1613–6939 ($1,825–7850) MS-related (Parise et al⁵⁶)	- $53,438–74,055 ($58,997–81,890) per patient (aggregating Parisé et al⁵⁶ and Jones et al⁵⁵)	- 51.2% of working age adults reported using a mobility device; 68.2% reported having some level of mobility limitation (Bishop et al⁵⁷) - 14.1% and 7.5% of patients on DMDs report malaise/fatigue and gait abnormality, respectively (Carroll et al¹¹²)	- 40.7–48.1% employment post-diagnosis (full- or part-time), compared to 88.2% at time of diagnosis (Bishop et al⁵⁷; Krause et al, 2019;⁵⁹ Krause et al, 2018⁵⁸)
Osteoarthritis	- 13.4% (30.8 million) (Cisternas et al³³^) - 15.1 million adults ≥25 with symptomatic knee OA (Deshpande et al³⁵^) - 19.6% age-standardized prevalence of radiographic hip OA; 4.2% age-standardized prevalence of symptomatic hip OA (Kim et al¹¹³) - 10.5% all-ages (IHME GBD Tool 201732t) - 32.5 million adults from 2008–2014 (BMUS 4^th ed.^30†) - 10.5% prevalence among all ages; peak prevalence is 47.8% aged 90–94 (IHME GBD Tool 2017^32†)	- 13.8% lifetime risk of diagnosed symptomatic knee OA (Losina et al³⁶^**) - 12.9% symptomatic hand OA over 12 years (Snyder et al¹¹⁴) - 1,300 per 100,000 for symptomatic hip OA(Moss et al¹¹⁵) - 460 per 100,000 among all ages; peak incidence is 1,216 per 100,000 among adults aged 60–64 (IHME GBD Tool 2017^32†)	- $373.2 ($459.5) billion national all-cause; $65.5 billion ($80.6) OA-related; $11,502 ($14,163) per pt all-cause; $2,018 OA-related (BMUS 4th ed.^30†) - $16.5 ($19.2) billion in national inpatient spending (Torio et al¹¹⁶) - $14,521 ($15,435) per pt all-cause general OA in a working-age population; $10,892 ($11,578) incremental; $23,272 ($24,737) all-cause hipOA; $19,551 ($20,782) all-cause spine OA; $15,599 ($16,581) all-cause knee OA; and $10,112 ($10,749) all-cause hand OA (Wang et al³⁴^) - $19,600 ($22,726) knee OA-related lifetime cost (Losina et al³⁷^) - $1,229 ($1274) per pt knee OA-related (Ong et al¹¹⁷)	- $113.2 ($128.0) billion all-cause earnings lost; $71.3 ($80.7) billion OA-related earnings lost; $6,783 ($7,673) per pt earnings lost; $4,274 ($4,835) OA-related per pt earnings lost (BMUS 4th ed.^30†)	- $486.4 ($550.2) billion total direct and indirect costs of OA and allied disorders; $136.8 ($154.8) billion total OA-related costs (BMUS 4th ed.^30†)	- 43.5% of individuals with arthritis (23.7 million) had arthritis-attributable activity limitations, the majority of which are likely attributed to osteoarthritis) (Barbour et al²⁷)	- 180.9 million total lost work days reported by adults with arthritis between 2013–2015; the majority likely attributed to osteoarthritis (BMUS 4th ed.^30†)
Rheumatoid Arthritis	- 0.5% (1.3–1.4 million adults) (Hunter et al³⁸^**) - 0.8% (1.7 million adults on average from 2008–2012) (BMUS 4th ed.^30†) - 2.0% among Medicare beneficiaries (Li et al¹¹⁸) - 0.63% (Crane et al¹¹⁹) - 0.6% prevalence among all ages’ peak prevalence is 1.7% among adults aged 70–74 (IHME GBD Tool^32†)	- 71 per 100,000 age- and sex-adjusted rate for persons at risk (Crane etal¹¹⁹) - 30.2 per 100,000 incidence among all ages; 77 per 100,000 peak incidence among adults aged 65–69 (IHME GBD Tool 2017^32†)	- $32.9 ($40.5) billion national all-cause; $13.8 ($17.0) billion RA-related (BMUS 4th ed.^30†) - $20,919 ($24,255) all-cause RA in Medicare population;$13,722 ($15,911) incremental; $11,587 ($13,435) RA-related (Chen I Chieh et al³⁹^*) - $12,509 ($13,800) per pt all-cause; $3,723 ($4,107) per pt RA-related costs (Hresko et al¹⁴^) - $14,158 ($14,682) per pt RA-related (Li et al¹²⁰) - $5,317 ($6,020) RA-related costs for pts on targeted immunomodulators (Strand et al⁴²)	- $13.1 ($14.8) billion national earning loss and $14,542 ($16,450) per pt earning losses; RA-related earning losses were $7.9 ($8.9) billion in aggregate and $8,748 ($9,896) per pt (BMUS 4th ed.^30†) - $596 ($704) per pt incremental; $252 ($298) million national cost due to RA-related absenteeism (Gunnarsson et al⁴⁰^**) - $3,324 ($3,573) RA-related per pt on targeted immunomodulators (Strand et al⁴²)	- $46 ($52) billion national all-cause; $21.6 ($24.4) billion RA-related costs (BMUS 4th ed.^30†) - $8,641 ($9,593) per pt for RA-related, targeted immunomodulators (Strand et al⁴²)	- 236% higher relative prevalence of functional disability compared to age-matched controls (Myasoedova et al⁴¹)	- 20.3 days of work lost per yr for pts on targeted immunomodulators (Strand et al⁴²) - 13.7 workdays missed per yr (about 4 days more than those without condition) (Gunnarsson et al⁴⁰)
Spinal Cord Injury	- 2.6 million (James et al^61†) - 291,000 (National Spinal Cord Injury Statistical Center^60†) - 1.5 million (Armour et al^62†)	- 52–54 per 1,000,000 traumatic (Jain et al⁶³^, National Spinal Cord Injury Center^60†) - 56.4 per 1,000,000 traumatic (Selvarajah et al⁶⁵^) - 260 per 1000,000 (James et al^61†)	Overall: - $1.7 ($2.2) billion cost of hospital izations (Mahabaleshwarkar and Khanna⁶⁶^*) - $1.6 ($2.1) billion acute treatment (Selvarajah et al⁶⁵^) - $42,323 ($50,280) and $35,883 ($42,629) all-cause costs for patients with and without neuropathic pain, respectively (Margolis et al¹²¹) Cervical: - $1,129,302 ($1,148,407) in first yr then $196,107 (199,425) per yr after in SCI-related costs (DeVivo et al;⁶⁸ National Spinal Cord Injury Center^60†) -$160,000-$180,000 ($166,000–187000) in hospitalization costs per pt ≥65 (Asemota et al¹²²)	- $76,327 ($77,334) per person (National Spinal Cord Injury Center, 2019^60†)	- $9.7 ($15.7) billion (Berkowitz et al⁶⁹ p. 81; Ma et al⁵)	Overall: - Average spasticity was mild and persists in roughly 85% of pts (DiPiro et al⁷¹) Cervical: - Of those with CSCI, roughly 60% incomplete tetraplegia vs 40% complete tetraplegia. Of all DALYs associated with SCI, cervical SCIs account for roughly 66% (Hall et al⁶⁷)	- 35% employed after SCI (Trenaman et al;⁷² Ottomanelli et al⁷³)
Stroke	- 2.5% or 7.0 million adults ≥20 yrs (Benjamin et al^74†) - 2.9–3.7% of adults (Blackwell and Villarroel;^76†CDC^106†) - 2.6% among all ages; peak prevalence is 17.3% among adults aged 90–94 (IHME GBD Tool 2017^32†)	- 192 per 100,000 men; 198 per 100,000 women (Madsen et al⁷⁹^**) - 127 per 100,000 acute ischemic stroke (Alqahtani et al¹²³) - 373 per 100,000 for total stroke; 329 per 100,000 for ischemic; 49 per 100,000 for hemorrhagic stroke (Koton et al¹²⁴) - 639 per 100,000 first stroke in pts ≥65 years old (Fang 2014¹²⁵) - 795,000 cases of new/recurrent stroke based on 1999 data (Benjamin et al^74†) - 185 per 100,000 incidence among all ages; peak incidence is 2,085 per 100,000 among adults aged 90–94 (IHME GBD Tool 2017^32†)	- $21,916 ($32103) mean hospital charges for acute ischemic stroke in 2016 (Yacoub et al⁸²^*) - $28 ($30.9) billion (Benjamin et al^74†) - $2.34 ($2.78) billion national hospitalization costs due to subarachnoid hemorrhage, $2.52 ($2.99) billion due to ischemic hemorrhage, and $12.55 ($14.9) billion due to acute ischemic stroke (Tong etal⁸³^) - $18,796 ($22,330) per pt all-cause medical costs (Chinthammit et al^89*) - $24 ($25.5) billion incremental among patients with hypertension who have stroke (Lekoubou et al⁸⁰^) - $46,518 ($61,046) per admission (Stepanova et al⁸¹^*) - $46,850 ($51,684) all-cause medical costs in first year post-injury (Mu et al⁸⁷) - All-cause costs were $61,354 ($71,139) per pt on commercial health insurance vs $44,929 ($52,095) per pt on Medicare in first year (Johnson et al;¹²⁶ Katan and Luft¹²⁷) - $20,396 ($27,611) per admission for primary and secondary diagnosis of stroke (Wang et al¹²⁸)	- $30 ($31.1) billion stroke-related lost productivity (RTI International¹²⁹) - $33.65 ($39.25) billion lost productivity (Ovbiagele et al⁸⁴^*) - $8,211 ($9,703) per pt annual cost due to informal caregiving (Joo et al⁸⁵^)	- $45.5 ($48.8) billion stroke-related (Benjamin et al^74†)	- 3% of males and 2% of females attribute disability to stroke (Benjamin et al^74†) - 60% reported at least some difficulty (w/ or w/o assistive device) in completing ADLs (≥65 years old) (Brenner et al⁹⁰) - Majority reported severe to extreme difficulty with standing for long periods and walking a long distance (64.5%). Pts were restricted in self-care activities including bathing (40.8%) and performing household tasks (40.2%) (older Americans, most commonly 60–69 yrs old) (Arowoiya et al⁹¹) - 22% were discharged with disability (mean age of 64 years old) (Mu et al⁸⁷) - Significantly higher percentage of patients with stroke (>65 yrs) report balance/coordination problems (52.4%) and use of a mobility device (22.8%) compared to controls without stroke (Wing etal⁹²) - 23.1% reported ADL limitation (>50 yrs) (Chinthammit et al⁸⁹) - 65–121% more likely to require help in self-care, mobility, and household activities than matched controls (≥65 years old) (Skolarus et al⁸⁸)	- 45.6% of participants with stroke in a community stated that they were unemployed as a result of their stroke (60–69 yrs) (Arowoiya et al⁹¹)
TBI	- Age-standardized rate of 605 per 100,000 (James et al^61†) - 21.7% of state-based population report at least 1 TBI with LOC in lifetime (Corrigan et al¹³⁰) - 42.5% of state-based population report lifetime history of TBI, the most common of which was mild TBI (Whiteneck et al¹⁰²)	- 2.8 million annual TBI-related emergency department visits, hospitalizations, and deaths among all ages (Taylor et at al⁹³^) - 807.9 mild TBI per 100,000 ED visits (Cancelliere et al⁹⁸^) - 1.6% of all injury- or illness-related ED visits in one state contained diagnosis code for TBI (Kerr et al¹³¹) - 2.9 million TBI-related ED visits, hosp., deaths among all ages (CDC^94†) - Age-standardized rate of 333 per 100,000 (James et al^61†)	- $21.4 ($27.2) billion TBI-related admissions and $8.2 ($10.4) billion discharges/transports (Marin et al⁹⁹^*) - $9.2 ($17.4) billion injury-related (Finkelstein et al¹⁰⁰ p. 68; Ma et al⁵)	- $51.2 ($75.6) billion (Finkelstein et al¹⁰⁰ p. 104; Ma et al⁵)	- $60.4 ($93.0) billion in lifetime costs (Finkelstein et al¹⁰⁰ p. 136; Ma et al⁵)	- Roughly 50% do not return to pre-injury level in 1 year (Nelson et al¹⁰¹) - Based on state data, 41% of hospitalized pts with TBI and 33% of non-hospitalized pts with TBI report activity limitations. Prevalence of activity limitations increased by up to 307% compared to healthy controls without TBI, in accordance with injury severity (Whiteneck et al¹⁰²) - Of those with moderate to severe TBI at 1 year post-injury, FIM scores were lowest in the domains of stair climbing, memory, and problem solving (Brooks et al¹³²)	- More than half of moderate/severe TBI were unemployed at 2 and 5 years post-injury (Cuthbert et al;¹⁰³DiSanto et al¹⁰⁴) - Roughly 80% of veterans with severe TBI were unemployed 1 year post-injury (Dillahunt-Aspillaga et al¹⁰⁵)

^*=

fair quality;

^**=

good quality OR no major flaws;

^†=

grey literature

Abbreviations:ADL – activities of daily living; cLBP – chronic low back pain; CSCI – cervical spinal cord injury; DALY – disability-adjusted life year; DMD – disease modifying drug; ED – emergency department; LBP – low back pain; LEA – lower extremity amputation; LOC – loss of consciousness; MS – multiple sclerosis; OA – osteoarthritis; PT – patient; RA – rheumatoid arthritis; SCI – spinal cord injury; TBI – traumatic brain injury; YR – year