The interaction of COVID-19 and sociodemographic factors on pediatric rehabilitation service initiation

This study examined the effect of the COVID-19 (COVID) pandemic on pediatric rehabilitation referrals and service initiation. In a retrospective cohort study, we examined rehabilitation service utilization in 32 721 children between 2018 and 2022. Descriptive statistics compared service initiation rates by key patient characteristics during the pre-COVID/COVID periods and logistic regression estimated the changes in service initiation. During COVID, service initiation decreased significantly by 23% (<i>p</i> &lt; 0.001), whereas referral rates remained stable. The multivariate model showed that the rate of service initiation decreased faster for children aged 13–18 years than children aged 0–2 years (−11.1 vs. −6.8 percentage points (pps)). Speech-language pathology service initiation decreased significantly more than physical therapy during COVID (−12.2 vs. −6.5 pps), and urban service initiation rates decreased more than rural rates (9.2 vs. 0.9 pps). Disparities in service initiation by race, insurance type, urban/rural location, and primary language were persistent prior to and during COVID. Policies and procedures are needed to address disparities that existed prior to and during COVID in rehabilitation services access. It is critical to screen children for rehabilitation needs that may have gone untreated during COVID to optimize functional outcomes and quality of life. Pediatric rehabilitation service initiation significantly declined during the COVID-19 pandemic.Health care professionals should screen if children and adolescents had unmet service needs during the pandemic, particularly non-White individuals, rare language speakers, rural residents, public insurance holders, and/or those referred to speech-language pathology.Policies, procedures, and interventions are needed to address persistent disparities in pediatric rehabilitation. Pediatric rehabilitation service initiation significantly declined during the COVID-19 pandemic. Health care professionals should screen if children and adolescents had unmet service needs during the pandemic, particularly non-White individuals, rare language speakers, rural residents, public insurance holders, and/or those referred to speech-language pathology. Policies, procedures, and interventions are needed to address persistent disparities in pediatric rehabilitation.