Change in Function Over Inpatient Rehabilitation After Hypoxic Ischemic Brain Injury: A Population-Wide Cohort Study

Published:February 20, 2019DOI:



      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.

      Main Outcome Measure

      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.


      List of abbreviations:

      CIHI-DAD (Canadian Institute for Health Information Discharge Abstract Database), HIBI (hypoxic-ischemic brain injury), ICD-10 (International Classification of Disease, 10th revision), IR (inpatient rehabilitation), LOS (length of stay), NRS (National Rehabilitation Reporting System), OLS (ordinary least squares), TBI (traumatic brain injury)
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