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To identify determinants of discharge disposition from acute care among survivors of hypoxic-ischemic brain injury (HIBI), stratified by sex. Population-based retrospective cohort study using provincial data in Ontario, Canada. The determinants were grouped into predisposing, need, and enabling factors using the Anderson Behavioral Model. Acute care. Survivors of HIBI aged ≥20 years at the time of hospitalization and discharged alive from acute care between April 1, 2002, and March 31, 2017. There were 7492 patients with HIBI, of whom 28% (N=2077) survived their acute care episode. Not applicable. Discharge disposition from acute care, categorized as complex continuing care (CCC), long-term care (LTC), inpatient rehabilitation (IR), home with support, home without support, and transferred to another acute care. The discharge dispositions for the 2077 survivors were IR 23.4% (n=487), CCC 19.5% (n=404), LTC 6.2% (n=128), home without support 31.2% (n=647), home with support 15.1% (n=314), and other 4.6%. Multinomial multivariable logistic regression analysis using home without support as the reference category revealed that female patients were significantly more likely than male patients to be discharged to LTC/CCC. Those who were older, were frail, and had longer stay in acute care or special care unit (SCU) were more likely to be discharged to LTC/CCC. The only significant determinant for IR was longer stay in acute care. Survivors with cardiac-related injury were less likely to be discharged to LTC/CCC. Income was a significant factor for male patients but not for female patients in the sex-stratified analysis. The following variables were investigated but were not significant determinants in this study: need factors (comorbidity score, prior psychiatric disorders, health care utilization) and enabling factors (income quintile, rural area of residence). Predisposing (age, sex) and need factors (frailty, acute care days, SCU days, type of injury) were significant determinants of discharge disposition from acute care after HIBI. In spite of a system with universal coverage, sex differences were found, with more female patients being discharged to CCC/LTC rather than IR, controlling for age and other confounders. These findings should be considered in appropriate discharge planning from acute care for survivors of HIBI. [ABSTRACT FROM AUTHOR]

To understand how health status preceding traumatic brain injury (TBI) affects relative functional gain after inpatient rehabilitation using a data mining approach. Population-based, sex-stratified, retrospective cohort study using health administrative data from Ontario, Canada (39% of the Canadian population). Inpatient rehabilitation. Patients 14 years or older (N=5802; 63.4% male) admitted to inpatient rehabilitation within 1 year of a TBI-related acute care discharge between April 1, 2008, and March 31, 2015. Not applicable. Relative functional gain (RFG) in percentage, calculated as ([discharge FIM−admission FIM]/[126−admission FIM]×100). Health status prior to TBI was identified and internally validated using a data mining approach that categorized all International Classification of Diseases, 10th revision, codes for each patient. The average RFG was 52.8%±27.6% among male patients and 51.6%±27.1% among female patients. Sex-specific Bonferroni adjusted multivariable linear regressions identified 10 factors of preinjury health status related to neurology, emergency medicine, cardiology, psychiatry, geriatrics, and gastroenterology that were significantly associated with reduced RFG in FIM for male patients. Only 1 preinjury health status category, geriatrics, was significantly associated with RFG in female patients. Comorbid health conditions present up to 5 years preceding the TBI event were significantly associated with RFG. These findings should be considered when planning and executing interventions to maximize functional gain and to support an interdisciplinary approach. Best practices guidelines and clinical interventions for older male and female patients with TBI should be developed given the increasingly aging population with TBI. [ABSTRACT FROM AUTHOR]

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. Inpatient rehabilitation. Survivors of HIBI 20 years and older discharged from acute care between fiscal years 2002-2003 and 2010-2011 and admitted to IR within 1 year of acute care discharge (N=159). Not applicable. Functional status as measured by FIM, total, and scores on motor and cognitive subscales. A higher proportion (77%) of HIBI patients in the study were male and 28% were older than 65 years. We observed material improvements in FIM total, motor, and cognitive scores from across the IR episode. Potential determinants of total FIM 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 gain had similar identified potential determinants. Identified potential determinants of cognitive FIM gain were shorter (ie, 31-60 vs >60 days) preceding acute care, longer IR and 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. [ABSTRACT FROM AUTHOR]

To understand the types and contexts of rehabilitation care currently available for survivors of IPV, opportunities identified in the literature for rehabilitation care, and IPV awareness and education of rehabilitation care providers. Ten databases were comprehensively searched to identify articles related to IPV and the rehabilitation professions of interest. This search was complimented by a grey literature search of relevant IPV, gender-based violence, and rehabilitation organizations. Searches were not limited by language, year of publication, or geographic location. Two reviewers independently assessed articles for inclusion based on the following criteria: (1) Describe or evaluate a rehabilitation intervention or opportunity for intervention, or an educational or awareness intervention for rehabilitation professionals; AND (2) focus on selected rehabilitation professionals (occupational therapist, physiotherapist, speech language pathologists, physiatrists); AND (3) focus on interventions for or about adult survivors of IPV. One researcher independently extracted data which was peer reviewed by a second reviewer. Extracted information included publication details (author, year, location), study details (objective, design, setting), and information on study populations, interventions, and outcomes, when appropriate. Included articles ranged from primary research articles to clinical newsletter articles. While all rehabilitation professionals of interest were represented in the included articles, most focused on occupational therapy (>70%). A large majority of articles (>70%) suggested opportunities for rehabilitation professionals to support survivors of IPV. Most provided an overview of IPV followed by recommendations for rehabilitation professionals in supporting survivors. The remaining examined specific interventions for IPV survivors (< 15%) or assessed for knowledge, attitudes, or beliefs about IPV (< 15%). To our knowledge, this is the first scoping review addressing the rehabilitation literature for IPV survivors. Though still preliminary, these findings suggest there is an awareness of IPV among rehabilitation professionals, the importance of identifying IPV in clients, and the ways in which rehabilitation professionals are uniquely situated to support survivors of IPV. There remains opportunity to explore interventions designed specifically for IPV survivors. The authors have no conflicts to disclose. [ABSTRACT FROM AUTHOR]

Objective To investigate demographic and acute care clinical determinants of admission to inpatient rehabilitation (IR) among patients with hypoxic-ischemic brain injury (HIBI) who survive the initial acute care episode. Design Population-wide prospective cohort study using Canadian Institutes for Health Information administrative health data from Ontario, Canada. All patients who survived their HIBI acute care episode during the study period remained eligible for the outcome, admission to IR, for 1 year postacute care discharge. Setting Inpatient rehabilitation. Participants We included all patients with HIBI using International Classification of Diseases, Tenth Revision, Canadian Enhancement codes recorded at acute care admission who were ≥20 years old (N=599) and discharged from acute care between the 2002 and 2010 fiscal years, inclusive. Six patients were excluded from analyses because of missing data. Interventions Not applicable. Main Outcome Measure Admission to IR. Results Of HIBI survivors admitted to IR within 1 year of acute care discharge (n=169), most (56.2%) had an IR admitting diagnosis indicating anoxic brain damage. Younger age, being a man, lower comorbidity burden, longer length of stay of preceding acute care episode, and shorter duration in special care were most predictive of admission to IR in multivariable regression models. Women had an almost 2-fold lower incidence of admission to IR (risk ratio, .62; 95% confidence interval, .46–.84). Conclusions Older age, higher comorbidity burden, and shorter lengths of stay and delayed discharge from acute care are associated with lower incidence of IR admission for patients with HIBI. That women are almost 2-fold less likely to receive rehabilitation requires further investigation. [ABSTRACT FROM AUTHOR]

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 Inpatient rehabilitation. Participants Patients in inpatient rehabilitation for a TBI within 1 year of acute care discharge between 2008/2009 and 2011/2012 (N=1730, 70% men, 30% women). Interventions None. Main Outcome Measures Inpatient rehabilitation length of stay, total 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. Although many of the predictors examined were similar across men and women, sex-specific multivariable models identified some predictors of rehabilitation outcome that are specific for men and women; mechanism of injury ( P <.0001) was a significant predictor of functional outcome only among women, whereas comorbidities ( P <.0001) was a significant predictor for men 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. [ABSTRACT FROM AUTHOR]

To understand how pre-injury health status present five-years preceding traumatic brain injury (TBI) affects direct medical cost two years post-injury. Retrospective cohort study. Publicly funded healthcare system in Ontario, Canada. Patients age 19 years or older in the emergency department (ED) or acute care for a TBI between April 1, 2007 and March 31, 2014 (N=55,669). N/A. Direct medical costs within two years of discharge. Patients who received care in the ED (81.9% of total sample) incurred a median cost of $2,492/male patient (average $12,342/patient) and $3,508/female patient (average $12,372/patient) within two years of injury; 37 pre-injury factors were significantly associated with increased direct medical costs. Patients who first received care for their TBI in acute care (18.1%) incurred a median cost of $25,081/male patient (average $63,060/patient) and $30,277/female patient (average $65,285/patient) within two years of injury; 21 factors were significantly associated with increased direct medical costs. Among more prevalent factors, those associated with increased medical cost by at least 50% included mental health disorders, substance abuse, disorders or medical conditions frequently observed among the elderly, cardiovascular disorders, stroke and emergencies involving the brain, metabolic disorders and abdominal symptoms, conditions and symptoms of abdomen and pelvis, genitourinary disorders and disorders of prostate, and pulmonary abdominal and other emergencies. Direct medical costs two years post-TBI differed significantly between patients with and without adverse pre-existing health status. Interdisciplinary teams to promote early identification of pre-existing health conditions and appropriate management and integration of these conditions in TBI care across the continuum of healthcare may be opportunities to reduce direct medical costs post-injury. None. [ABSTRACT FROM AUTHOR]

To systematically identify and synthesize existing evidence on comorbidity-related implications in adults with TBI. Systematic searches were conducted in Medline, Cochrane Central Register of Controlled Trials, Embase, and PsycINFO, from May 1997 to September 2020. Peer-reviewed English journal articles on prospective and retrospective longitudinal studies focusing on comorbidity in relation to cognitive or physical functioning in adult patients with TBI, were considered eligible. Letters to editors, reviews without data, case reports, conference abstracts, articles without primary data, studies that focus on therapeutic interventions, and theses, were excluded. Three researchers independently screened and assessed articles for fulfillment of the inclusion criteria. Quality assessment followed the Quality in Prognosis Studies tool and the Scottish Intercollegiate Guidelines Network methodology recommendations. A total of 15,278 citations were abstracted from databases searched. Twenty-two studies of moderate quality discussed effects of comorbidities on functional outcomes in patients with TBI. The extracted data were synthesized through tabulation and qualitative description. Cognitive and physical functioning were negatively affected by a wide range of studied comorbidities, including systemic medical diseases, psychiatric conditions, and neurological disorders. The effect of comorbidity, even within the same categories of comorbidity and functional outcome, differed across studies. Severity of TBI, sex/gender, and age were important factors in the relationship. Due to methodological heterogeneity between studies, meta-analyses were not performed. This systematic review highlights the adverse effect of comorbidities on functional outcome in patients with TBI and enhances our understanding of their impact for both patients with TBI and clinicians who treat and rehabilitate these patients. It is essential to be aware of these comorbidity-related functional implications. PROSPERO registration (CRD 42017070033). The authors have no conflicts of interest to declare. [ABSTRACT FROM AUTHOR]

To understand how health status preceding traumatic brain injury (TBI) affects relative functional gain after inpatient rehabilitation. Population-based, sex-stratified, retrospective cohort study using health administrative data. Inpatient rehabilitation in Ontario, Canada. Patients 14 years or older (N=5,802; 63.4% males) admitted to inpatient rehabilitation within 1 year of a TBI-related acute caredischarge between April 1, 2008, and March 31, 2015. N/A. Relative functional gain (RFG) in percentage. Health status prior to TBI was identified and internally validated using a data mining approach that categorized all International Classification of Diseases, 10th revision, codes for each patient. The average RFG was 52.8% +/- 27.6% among male patients and 51.6% +/- 27.1% among female patients. Sex-specific Bonferroni adjustedmultivariable linear regressions identified 10 factors of pre-injury health status related to neurology, emergency medicine, cardiology, psychiatry,geriatrics, and gastroenterology that were significantly associated with reduced RFG for male patients. Only 1 pre-injury health statuscategory, geriatrics, was significantly associated with RFG in female patients. Pre-existing health conditions present up to 5 years preceding the TBI event were significantly associated with RFG. These findingsshould be considered when planning and executing interventions to maximize functional gain and to support an interdisciplinary approach. None. [ABSTRACT FROM AUTHOR]