Sex-Specific Predictors of Inpatient Rehabilitation Outcomes After Traumatic Brain Injury

Abstract

Objective To identify sex-specific predictors of inpatient rehabilitation outcomes among patients with a traumatic brain injury (TBI) from a population based perspective. Design Retrospective cohort study Setting Ontario, Canada Participants Patients in inpatient rehabilitation for a TBI within one year of acute care discharge between 2008/09 and 2011/12 (N=1,730, 70% male, 30% female). Interventions None Main Outcome Measures Inpatient rehabilitation length of stay, total Functional Independence Measure (FIM™) score, and motor and cognitive FIM™ ratings at discharge. Results Sex, as a covariate in multivariable linear regression models, was not a significant predictor of rehabilitation outcomes. While many of the predictors examined were similar across males and females, sex-specific multivariable models identified some predictors of rehabilitation outcome that are specific for males and females; mechanism of injury (p<.0001) was a significant predictor of functional outcome only among females while comorbidities (p<.0001) was a significant predictor for males only. Conclusions Predictors of outcomes after inpatient rehabilitation differed by sex, providing evidence for a sex-specific approach in planning and resource allocation for inpatient rehabilitation services for patients with TBI.

Occupational and Physical Therapy Activities and Level of Effort in Patients With Traumatic Brain Injury: Association With Functional Outcomes

“…The primary comparison of the baseline factors and functional scores between results of the current study and data of the National Rehabilitation Reporting System (NRS) on IR facilities in Ontario for patients with TBI (n = 1730) during the same period shows relatively similar profiles. This suggests that the patient population in our study is more generalizable to other IR facilities in Ontario (NRS Ontario data: age (20‐64 years) 53.9%, male 70.1, admission FIM cognitive (23.5 ± 7.5), and admission FIM motor scores (58.9 ± 22.2)) . These data are also comparable to the NRS reports on IR facilities in Canada (n = 4503) .…”

“…Therapeutic factors as the target variables were entered in the last step, regardless of their significant value. Confounding factors (demographic and clinical factors) were chosen based on the availability of variables in the dataset, results of univariate regression, and results of previous studies …”

“…During IR, a transdisciplinary team provides postinjury care for patients . This team includes trained specialists in occupational therapy (OT), physical therapy (PT), speech language pathology (SLP), psychology, and physical medicine and rehabilitation . Results of prior studies have shown that IR outcomes can be greatly influenced by patient characteristics, clinical features, and variation in rehabilitation facilities …”

Gender, Sex and Traumatic Brain Injury: Transformative Science to Optimize Patient Outcomes

“…Our laboratory has been at the forefront of examining sex and gender in rehabilitation contexts so as to inform gaps in care. Our findings show that 70.2% of TBI rehabilitation patients are male, with the greatest representation of female patients being in the older adult group (51%) (Chan et al 2016). Before stratification, sex as a covariate in the multivariable linear regression models was not a significant predictor of rehabilitation outcomes (Chan et al 2016).…”

“…Our findings show that 70.2% of TBI rehabilitation patients are male, with the greatest representation of female patients being in the older adult group (51%) (Chan et al 2016). Before stratification, sex as a covariate in the multivariable linear regression models was not a significant predictor of rehabilitation outcomes (Chan et al 2016). When data were stratified and analyzed by sex, potential sex-and gendersensitive predictors of rehabilitation outcomes became evident.…”