Psychological stress can be viewed as occurring when demands exceed an individual's adaptive capacity. Burnout is an occupational syndrome defined by three dimensions, emotional exhaustion, depersonalization and feelings of low personal accomplishment. Factors related to the nature of the physiotherapy practice, in which health care is provided to patients under painful experiences and chronical conditions, to aspects related to emotional fatigue brought by interpersonal exchanges or physical exhaustion due to staff shortage, within an increasingly demanding health care system, expose physiotherapists to a higher risk of burnout and few studies have examined burnout in this specific setting.  Therefore, the aim of the present study was to assess the prevalence of burnout in Portuguese physiotherapists and to explore possible associations between burnout and demographic and work-related variables. Significant but weak association was found between age and emotional exhaustion, and between clinical experience and emotional exhaustion and global burnout score. Weak association was also found between the number of treated patients daily and daily working hours and physical fatigue and global burnout. Workload was associated with significantly higher scores of physical fatigue, cognitive weariness and global burnout. The prevalence of burnout was not high but significant differences were found in the prevalence of physical fatigue between the group with low workload and high workload. Emotional exhaustion was the most relevant predictor of the global burnout score. In conclusion, the results suggest that the prevalence of burnout in Portuguese physiotherapists is not very high, however, workload seems to place these professionals at a higher risk of developing burnout.

In the Spanish setting, ITB Therapy® resulted in an ICER close to €30,000/QALY gained; potential ways to reduce costs and further enhance efficiency can be identified.

A399Objectives: Health care resource utilization and costs were evaluated for patients diagnosed with multiple sclerosis (MS) in the U. S. Medicaid program. MethOds: Patients diagnosed with MS (International Classification of Disease, 9 th Revision, Clinical Modification [ICD-9-CM] diagnosis code 340) were identified using Medicaid data from 01JAN2008 through 31DEC2010. The initial diagnosis date was designated as the index date. Patients of the same age, race, and gender but without an MS diagnosis were identified and matched as the comparison cohort, with a randomly chosen index date to minimize selection bias. Patients in both groups were required to be at least age 18 years, and have continuous medical and pharmacy benefits 1 year before and 1 year post-index date. One-to-one propensity score matching (PSM) was used to compare health care costs and utilizations during the follow-up period, between the diseased and the comparison cohorts, and adjusted for baseline demographic and clinical characteristics. Results: After risk adjustment by PSM, a total of 14,179 patients in each cohort were matched. Significantly more MS patients had inpatient admissions (23.75% vs. 10.87%, p< 0.0001) and long-term care (22.64% vs. 4.13%, p< 0.0001), other service (99.70% vs. 89.00%, p< 0.0001) and pharmacy visits (73.08% vs. 67.71%, p< 0.0001) compared to those without an MS diagnosis. Higher health care utilization by MS patients led to significantly higher inpatient ($1,688 vs. $725, p< 0.0001), long-term care ($14,189 vs. $2,778, p< 0.0001), other service visit ($22,981 vs. $9,977, p< 0.0001) and pharmacy costs ($5,284 vs. $1,785, p< 0.0001) compared to those without MS. cOnclusiOns: Compared to patients in the comparator cohort, MS patients in the Medicaid program incurred substantially higher health care resource utilization and costs.

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apy. Methods: Observational, non-interventional, prospective, single-center study of 1 year follow-up from ITB implant onward. Results: 20 consecutive patients with ITB indication were recruited; 13 received an ITB implant during the study period; 1 implant was rejected and thus explanted. 12 patients, of whom 10 had spasticity due to spinal-cord injury, 1 to multiple sclerosis and 1 to adrenoleukodistrophy, provided data for the study and 9 completed follow-up. After 12 months of ITB, mean changes from baseline were: -2.6 on the Penn scale (p= 0.011), -1.1 (p= 0.059) and -2.8 (p= 0.011) on the Ashworth upper and lower scale, respectively and +4.4 on the FIM scale (p= 0.075). Mean utility gain, assessed with the HUI3 scale, was 0.054 (p= 0.091) after 1 year. Mean total ITB test and permanent implant cost per patient were € 528 and € 14,225, respectively. Mean quarterly spending on oral antispastics decreased by € 42 at month 12, while consumption of intrathecal baclofen stabilized after 6 months at € 39. At baseline, 4 patients received botulinum injections, while none did at the end of follow-up. Catheter-related adverse events occurred in 2 out of 12 patients, with a total mean cost per event of € 2.387. While waiting to receive ITB, spasticity-related hospitalizations due to urological complications occurred in 2 out of 20 patients, with a mean cost of € 9.044 per event; no such events were observed after ITB implant. ConClusions: Clinical outcomes of patients with N-FDS improved after ITB. Initial therapy costs were considerable, but were partially offset by savings in drugs and spasticity-related events after 1 year follow-up. Results should be interpreted cautiously because of the small number of observations. objeCtives: To assess clinical outcomes, health care resource utilization and associated costs of intrathecal baclofen therapy (ITB) for the treatment of non-focal disabling spasticity (N-FDS) in patients who are resistant or intolerant to oral ther-