Change in function over inpatient rehabilitation following hypoxic ischemic brain injury: A population-wide cohort study

Publication date: Available online 20 February 2019

Source: Archives of Physical Medicine and Rehabilitation

Author(s): David Stock, Binu Jacob, Vincy Chan, Angela Colantonio, Nora Cullen

Abstract

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).

Design

Population-based retrospective cohort study using Ontario's health administrative data.

Setting

Inpatient rehabilitation.

Participants

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

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 FIM^TM 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 FIM^TM gain had similar identified potential determinants. Identified potential determinants of cognitive FIM^TM 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.

Conclusions

Inpatient rehabilitation is beneficial to HIBI survivors. Timely access to these services may be crucial in achieving optimal outcomes for these patients.

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