Category: Brain Injury; Health Services Research
Objective : To estimate change in motor, cognitive and overall functional performance during inpatient rehabilitation (IR) and to identify potential determinants of these outcomes among patients with hypoxic-ischemic brain injury (HIBI).
Population-based retrospective cohort study using Ontario’s health administrative data.
Setting : Inpatient rehabilitation.
Participants (or Animals, Specimens, Cadavers) :
HIBI survivors age 20 years and older discharged from acute care between fiscal years 2002/03 and 2010/11 and admitted to IR within one year of acute care discharge, n=159.
Interventions : Not applicable.
Main Outcome Measure(s) :
Functional status as measured by Functional Independence Measure™ (FIM™), total and scores on motor and cognitive sub-scales.
Results : A higher proportion (77%) of HIBI patients in the study were male and 28% were older than 65 years of age. We observed material improvements in FIM total, motor and cognitive scores from across the IR episode. Potential determinants of total FIMTM gain were living in rural location (β: 10.4: 95% CI: 0.21, 21), having shorter preceding acute care length of stay (15-30 vs >60 days β:10.4: 95% CI: 1.4, 19.5) and failing to proceed directly to IR following acute care discharge (β: 8.7, 95% CI: 1.8, 15.5). Motor FIMTM gain had similar identified potential determinants. Identified potential determinants of cognitive FIMTM gain were shorter (i.e., 31-60 vs >60 days) preceding acute care, and longer IR, length of stay and proceeding directly to IR. There were no sex differences in functional gain.
Inpatient rehabilitation is beneficial to HIBI survivors. Timely access to these services may be crucial in achieving optimal outcomes for these patients.
David Stock– Senior Researcher, Dalhousie University, Halifax, Nova Scotia
Binu Jacob– Postdoctoral Fellow, Toronto Rehabilitation Institute-University Health Network, Toronto, Ontario
Vincy Chan– Scientific Associate III, Toronto Rehabilitation Institute-University Health Network, Toronto, Ontario
Angela Colantonio– Professor and Director, University of Toronto, Toronto, Ontario
Nora Cullen– Scientist, Toronto Rehabilitation Institute, Toronto, Ontario