Kautzky-Willer Alexandra, Harreiter Jürgen, Thomas Anita, Burger Johannes, Schneeweiß Ulrich, Deischinger Carola, Klein Wolfhard, Moser Hermann
Gender Medicine Institute, Gars am Kamp, Austria.
Gender Medicine Unit, Division of Endocrinology and Metabolism, Department of Medicine III, Medical University of Vienna, Vienna, Austria.
Front Aging Neurosci. 2021 Nov 18;13:663215. doi: 10.3389/fnagi.2021.663215. eCollection 2021.
Little is known about possible sex and gender differences in post-stroke neurorehabilitation outcomes. We aimed to analyze if functional performance, prevalence and impact of comorbidities at admission, and success of inpatient stroke-neurorehabilitation differ between men and women. Retrospective cohort analysis of 1,437 men and 907 women with prior cerebral infarction treated at a neurorehabilitation clinic between 2012 and 2017; multiple linear regression was used to examine the influence of sex/gender as well as multiple confounders on health and functional outcomes. The main outcome measures were Barthel index (BI) at admission and its change during 4 weeks inpatient neurorehabilitation. Men had been diagnosed with osteoporosis less frequently than women but more often with type 2 diabetes mellitus, coronary artery or chronic kidney disease ( ≤ 0.01). Although twice as many women presented with pre-stroke depression compared to men, the risk of post-stroke depression detected during rehabilitation was comparable. Men were more likely to have less than 30 days between diagnosis and neurorehabilitation start than women ( < 0.03). At admission, women exhibited less autonomy, a lower BI, a higher pain score and worse 2-min walk test (2'WT) compared to men ( < 0.001). Among males osteoporosis and peripheral artery disease independently predicted BI at admission, in women it was pre-stroke depression, dementia, and arterial fibrillation. During neurorehabilitation, both sexes improved regarding BI, pain and walk tests ( < 0.001). Despite comparable rehabilitation effectiveness, women still had worse functional outcomes than males at discharge. Time after stroke to start of neurorehabilitation and length of the stay but, most strongly, the simple 2'WT at admission, and in women, pain intensity independently predicted post-stroke functional status and recovery. Women presented with worse functional status at admission to neurorehabilitation. Although men and women showed similar rehabilitation effectiveness, women still displayed worse clinical outcome measures and higher levels of pain at discharge. Early access and gender-sensitive, personalized post-stroke care with more focus on different comorbidities and psychosocial factors like pain levels and management, could further improve neurorehabilitation outcomes.
关于中风后神经康复结果中可能存在的性别差异，目前所知甚少。我们旨在分析男性和女性在功能表现、入院时合并症的患病率及影响，以及住院中风神经康复的成功率方面是否存在差异。对2012年至2017年间在一家神经康复诊所接受治疗的1437名男性和907名曾患脑梗死的女性进行回顾性队列分析；采用多元线性回归来检验性别以及多个混杂因素对健康和功能结局的影响。主要结局指标为入院时的巴氏指数（BI）及其在4周住院神经康复期间的变化。男性被诊断出患有骨质疏松症的频率低于女性，但患2型糖尿病、冠状动脉疾病或慢性肾病的频率高于女性（≤0.01）。尽管中风前出现抑郁的女性人数是男性的两倍，但康复期间检测到的中风后抑郁风险相当。男性从诊断到开始神经康复的时间少于30天的可能性比女性更大（<0.03）。入院时，与男性相比，女性表现出更低的自主性、更低的BI、更高的疼痛评分以及更差的2分钟步行试验（2'WT）结果（<0.001）。在男性中，骨质疏松症和外周动脉疾病可独立预测入院时的BI，在女性中则是中风前抑郁、痴呆和房颤。在神经康复期间，男女在BI、疼痛和步行试验方面均有改善（<0.0）。尽管康复效果相当，但出院时女性的功能结局仍比男性差。中风后开始神经康复的时间和住院时间，以及最主要的，入院时简单的2'WT结果，在女性中则是疼痛强度，可独立预测中风后的功能状态和恢复情况。女性在进入神经康复时功能状态较差。尽管男性和女性的康复效果相似，但出院时女性仍表现出更差的临床结局指标和更高的疼痛水平。早期介入以及对性别敏感的个性化中风后护理，更多地关注不同的合并症以及疼痛水平和管理等社会心理因素，可能会进一步改善神经康复结局。
