Gender
With respect to gender effects, studies investigating rehabilitation outcomes among women have focused on long-term psychosocial outcomes associated with issues such as marriage or motherhood or issues associated with community and vocational reintegration (DeVivo et al. 1995; Stuart et al. 1998; Shackelford et al. 1998; Westgren & Levi 1994). However, there has been little research concerning the influence of gender on rehabilitation.
Discussion
Greenwald et al. (2001) employed a mixed, block design, matching male and female subjects to control for covariant effects of injury characteristics (level and AIS) and age at injury. They retrospectively analyzed 1,074 subjects over a 10-year period from 1988 to 1998 by using United States Model Systems data culled from 20 different SCI centers over a variety of geographic regions. In general, there were no significant differences between males and females for rehabilitation outcomes including discharge disposition, LOS, FIM motor scores (including change scores and efficiencies), or ASIA motor scores. There were also no reported gender-related differences in the incidence of most medical complications encountered during rehabilitation stay including pneumonia, autonomic dysreflexia, pulmonary embolism, cardiac arrest, kidney calculi, or gastrointestinal hemorrhage. However, men did have significantly higher rates for pressure sores although the authors reported that these differences were not robust and did not result in increased stays, charges, or lower functional outcomes.
One case control study conducted by Ronen et al. (2004) found that males experience greater rehabilitation LOS when compared to females. However, this may be related to injury type and severity rather than gender. Further analysis of this trend is necessary.
In one case series, New et al. (2005) found that males were more likely to be discharged home. Although these patients were also younger, more mobile, independent, and less severely impaired.
Studies have found mixed evidence for gender-related differences in the incidence of deep vein thrombosis in the SCI population. Greenwald et al. (2001) demonstrated a significantly higher rate of deep vein thrombosis in men while Furlan et al. (2005) found a higher rate in women.
The prevalence of psychiatric complications was found to be higher in women than men in the SCI population (Furlan et al. 2005). After SCI, women in the chronic stage had more symptoms of depression than men in the chronic stage (Furlan et al. 2005) but Krause et al. (2006) did not report a gender difference with regard to the number of days adversely impacted by poor mental health in women.
Pollard and Apple (2003) demonstrated that as a whole no gender-related differences were seen in neurological recovery. However, in contrast to Pollard and Apple (2003), Greenwald et al. (2001), and Furlan et al. (2005) studies, Sipski et al. (2004) found women’s ASIA motor scores were significantly higher than men’s 1 year after injury. Also, in contrast to Greenwald et al. (2001), Sipski et al. (2004) found men showed significantly greater FIM motor improvement than women by discharge. Additionally, there is some evidence to suggest that males experience more traumatic injuries than females as demonstrated by the findings of Gupta et al. (2008) and McKinley (McKinley et al. 2008; McKinley et al. 2002).
Overall, it appears there is only minimal evidence that suggests gender differences for most rehabilitation outcomes. Of note, the study with the strongest design (i.e., case control with matching to limit potential confounding) found few gender-related differences (Greenwald et al. 2001). Of note, Krause et al. (2006) found a significant difference between men and women in only one (i.e., non-routine physician visits) of six measures addressing healthcare utilization and general health status. Upon analysis of the effect of the potential mediating variables of education and income, it was found that these had substantially more impact on the likelihood of women having more nonroutine physician visits than did the role of gender differences.
Conclusion
There is conflicting level 3 (from three case control studies: Greenwald et al. 2001; Ronen et al. 2004; Scivoletto 2004) and level 4 evidence (from four case studies: Furlan et al. 2005; New 2005; Pollard & Apple 2003; Sipski et al. 2004) that there is no difference with respect to gender on discharge destination, rehabilitation LOS and neurological or functional outcomes associated with rehabilitation.
There is conflicting level 3 (from four case control studies: Gupta et al. 2008; McKinley et al. 2008; McKinley et al. 2002; Scivoletto et al. 2004) and level 4 evidence (from one case series: Sipski et al. 2004) that male patients experience more traumatic and incomplete injuries and of those that are female, younger females experience more complete injuries.
There is conflicting level 4 evidence (from one case series: Furlan et al. 2005) that women may experience more complications at admission, psychiatric complications, and deep vein thrombosis than men.
There is level 5 evidence (from one observational study: Krause et al. 2006) that female patients utilize more non-routine physician visits than males.
