Sex/gender differences in service use patterns, clinical outcomes and mortality risk for adults with acquired brain injury: a retrospective cohort study (ABI-RESTART)




brain injury, gender, sex, functional outcome, neurorehabilitation, service use


Objective: To identify sex/gender differences in functional, psychosocial and service use patterns in community-based post-acute care for acquired brain injury. 

Design: Retrospective cohort study.

Subjects/patients: Adults with acquired brain injury enrolled in post-acute neurorehabilitation and disability support in Western Australia (n = 1,011).

Methods: UK Functional Independence Measure and Functional Assessment Measure (FIM + FAM), Mayo-Portland Adaptability Inventory-4, goal attainment, length of stay (LOS), number of episodes of care and deaths were evaluated using routinely collected clinical and linked administrative data.

Results: At admission, women were older (p < 0.001) and displayed poorer functional independence (FIM + FAM; p < 0.05) compared with men. At discharge, there were no differences in goal attainment, psychosocial function or functional independence between men and women. Both groups demonstrated functional gains; however, women demonstrated clinically significant gains (+ 15.1, p < 0.001) and men did not (+ 13.7, p < 0.001). Women and men had equivalent LOS (p = 0.205). Aboriginal and/or Torres Strait Islander status predicted longer LOS for women but not for men. Being partnered predicted reduced LOS for women but not men. Women had a higher risk of multiple episodes of care (p < 0.001), but not death (p = 0.409), compared with that of men.

Conclusion: At admission to rehabilitation and disability support services for acquired brain injury, women have poorer functional independence and higher risk of multiple episodes of care, compared with men, suggesting greater disability in the community. By the time of discharge from these services, women and men make equivalent functional and psychosocial gains. The higher risk of multiple episodes of care for women relative to men suggest women may need additional post-discharge support, to avoid readmission.


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Australian Institute of Health and Welfare (AIHW). Disability in Australia: acquired brain injury. Bulletin no. 55. AUS 96. Canberra: AIHW; 2007.

Masel BE, DeWitt DS. Traumatic brain injury: a disease process, not an event. J Neurotrauma 2010; 27: 1529–1540. doi: 10.1089/neu.2010.1358 DOI:

Groff AR, Malec J, Braunling-Mcmorrow D. Effectiveness of post-hospital intensive residential rehabilitation after acquired brain injury: outcomes of 256 program completers compared to participants in a residential supported living program. J Neurotrauma 2020; 37: 194–201. doi: 10.1089/neu.2018.5944 DOI:

Jackson D, Seaman K, Sharp K, Singer R, Wagland J, Turner-Stokes L. Staged residential post-acute rehabilitation for adults following acquired brain injury: a comparison of functional gains rated on the UK Functional Assessment Measure (UK FIM+FAM) and the Mayo-Portland Adaptability Inventory (MPAI-4). Brain Inj 2017; 31: 1405–1413. doi: 10.1080/02699052.2017.1350998 DOI:

Troeung L, Mann G, Cullinan L, Wagland J, Martini A. Rehabilitation outcomes at discharge from staged community-based brain injury rehabilitation: a retrospective cohort study (ABI-RESTaRT), Western Australia, 2011–2020. Front Neurol 2022; 13. doi: 10.3389/fneur.2022.925225 DOI:

Borg DN, Nielsen M, Kennedy A, Drovandi C, Beadle E, Bohan JK, et al. The effect of access to a designated interdisciplinary post-acute rehabilitation service on participant outcomes after brain injury. Brain Inj 2020; 34: 1358–1366. doi: 10.1080/02699052.2020.1802660 DOI:

Curran C, Dorstyn D, Polychronis C, Denson L. Functional outcomes of community-based brain injury rehabilitation clients. Brain Inj 2015; 29: 25–32. doi: 10.3109/02699052.2014.948067 DOI:

Turner-Stokes L. Evidence for the effectiveness of multi-disciplinary rehabilitation following acquired brain injury: a synthesis of two systematic approaches. J Rehabil Med 2008; 40: 691–701. doi: 10.2340/16501977-0265 DOI:

Brain Injury Australia. About brain injury. 2016. [Accessed 20 January 2022]; Available from:

Mollayeva T, Mollayeva S, Colantonio A. Traumatic brain injury: sex, gender and intersecting vulnerabilities. Nature Rev Neurol 2018; 14: 711–722. doi: 10.1038/s41582-018-0091-y DOI:

Vaartjes I, Reitsma JB, Berger-van Sijl M, Bots ML. Gender differences in mortality after hospital admission for stroke. Cerebrovasc Dis 2009; 28: 564–571. doi: 10.1159/000247600 DOI:

Phan HT, Gall SL, Blizzard CL, Lannin NA, Thrift AG, Anderson C, et al. Sex differences in care and long-term mortality after stroke: Australian Stroke Clinical Registry. J Womens Health 2019; 28: 712–720. doi: 10.1089/jwh.2018.7171 DOI:

Stålnacke BM. Community integration, social support and life satisfaction in relation to symptoms 3 years after mild traumatic brain injury. Brain Inj 2007; 21: 933–942. doi: 10.1080/02699050701553189 DOI:

Poritz JMP, Vos L, Ngan E, Leon-Novelo L, Sherer M. Gender differences in employment and economic quality of life following traumatic brain injury. Rehabil Psychol 2019; 64: 65–71. doi: 10.1037/rep0000234 DOI:

Australian Bureau of Statistics. Standard for sex and gender variables. 2016. [Accessed 11 March 2022]; Available from:

Niemeier JP, Marwitz JH, Lesher K, Walker WC, Bushnik T. Gender differences in executive functions following traumatic brain injury. Neuropsychol Rehabil 2007; 17: 293–313. doi: 10.1080/09602010600814729 DOI:

Baguley IJ, Nott MT, Howle AA, Simpson GK, Browne S, King CA, et al. Late mortality after severe traumatic brain injury in New South Wales: a multicentre study. Med J Aust 2012; 196: 40–45. doi: 10.5694/mja11.10090 DOI:

Spitz G, Downing MG, McKenzie D, Ponsford J. Mortality following traumatic brain injury inpatient rehabilitation. J Neurotrauma 2015; 32: 1272–1280. DOI:

Ponsford JL, Myles PS, Cooper DJ, Mcdermott FT, Murray LJ, Laidlaw J, et al. Gender differences in outcome in patients with hypotension and severe traumatic brain injury. Injury 2008; 39: 67–76. doi: 10.1016/j.injury.2007.08.028 DOI:

Colantonio A, Harris JE, Ratcliff G, Chase S, Ellis K. Gender differences in self reported long term outcomes following moderate to severe traumatic brain injury. BMC Neurol 2010; 10: 102. doi: 10.1186/1471-2377-10-102 DOI:

Fabricius AM, D’Souza A, Amodio V, Colantonio A, Mollayeva T. women’s gendered experiences of traumatic brain injury. Qual Health Res 2020; 30: 1033–1044. doi: 10.1177/1049732319900163 DOI:

Carcel C, Woodward M, Wang X, Bushnell C, Sandset EC. Sex matters in stroke: a review of recent evidence on the differences between women and men. Front Neuroendocrinol 2020; 59. doi: 10.1016/j.yfrne.2020.100870 DOI:

Gall SL, Tran PL, Martin K, Blizzard L, Srikanth V. Sex differences in long-term outcomes after stroke. Stroke 2012; 43: 1982–1987. doi: 10.1161/STROKEAHA.111.632547 DOI:

Malec JF, Basford JS. Postacute brain injury rehabilitation. Arch Phys Med Rehabil 1996; 77: 198–207. doi: 10.1016/S0003-9993(96)90168-9 DOI:

Evans CC, Sherer M, Nakase-Richardson R, Mani T, Irby JW. Evaluation of an interdisciplinary team intervention to improve therapeutic alliance in post–acute brain injury rehabilitation. J Head Trauma Rehabil 2008; 23: 329–338. doi: 10.1097/01.HTR.0000336845.06704.bc DOI:

Powell J, Heslin J, Greenwood R. Community based rehabilitation after severe traumatic brain injury: a randomised controlled trial. J Neurol Neurosurg Psychiatry 2002; 72: 193–202. DOI:

Chan V, Mollayeva T, Ottenbacher KJ, Colantonio A. Sex-specific predictors of inpatient rehabilitation outcomes after traumatic brain injury. Arch Phys Med Rehabil 2016; 97: 772–780. doi: 10.1016/j.apmr.2016.01.011 DOI:

Mann G, Troeung L, Wagland J, Martini A. Cohort profile: The Acquired Brain Injury Community REhabilitation and Support Services OuTcomes CohoRT (ABI-RESTaRT), Western Australia, 1991-2020. BMJ Open 2021; 11: 1–15. doi: 10.1136/bmjopen-2021-052728 DOI:

Department of Health Government of Western Australia. Data Linkage Western Australia. 2020. [Accessed 24 August 2022]. Available from:

Australian Bureau of Statistics. The Australian statistical geography standard (ASGS) remoteness structure. 2018. [accessed 2023 Jan 10]. Available from:

Australian Bureau of Statistics. Socio-economic indexes for areas. 2018. [accessed 2023 Jan10]. Available from:

Turner-Stokes L, Nyein K, Turner-Stokes T, Gatehouse C. The UK FIM+FAM: development and evaluation. Clin Rehabil 1999; 13: 277–287. doi: 10.1191/026921599676896799 DOI:

Turner-Stokes L, Siegert RJ. A comprehensive psychometric evaluation of the UK FIM + FAM. Disabil Rehabil 2013; 35: 1885–1895. doi: 10.3109/09638288.2013.766271 DOI:

Malec J, Lezak MD. The Mayo-Portland Adaptability Inventory (MPAI-4). 2003.

Malec JF, Kean J, Monahan PO. The minimal clinically important difference for the Mayo-Portland adaptability inventory. J Head Trauma Rehabil 2017; 32: E47–54. doi: 10.1097/HTR.0000000000000268 DOI:

Turner-Stokes L. Goal attainment scaling (GAS) in rehabilitation: a practical guide. Clin Rehabil 2009; 23: 362–370. doi: 10.1177/0269215508101742 DOI:

World Health Organization (WHO). International Classification of Functioning, Disability and Health (ICF). 2017. [Accessed 18 July 2022]; Available from:

Hurn J, Kneebone I, Cropley M. Goal setting as an outcome measure: a systematic review. Clin Rehabil 2006; 20: 756–772. doi: 10.1177/0269215506070793 DOI:

Borgen IMH, Hauger SL, Forslund MV, Kleffelgard I, Brunborg C, Andelic N, et al. Goal attainment in an individually tailored and home-based intervention in the chronic phase after traumatic brain injury. J Clin Med 2022; 11. doi: 10.3390/jcm11040958 DOI:

Australian Institute of Health and Welfare. Australian Burden of Disease Study: Impact and causes of illness and death in Aboriginal and Torres Strait Islander people 2018. Australian Burden of Disease Study series no. 26. Cat. no. BOD 32. Canberra: AIHW; 2022.

Mackenzie CR. ‘It is hard for mums to put themselves first’: How mothers diagnosed with breast cancer manage the sociological boundaries between paid work, family and caring for the self. Soc Sci Med 2014; 117: 96–106. doi: DOI:

Troeung L, Mann G, Wagland J, Martini A. Effects of comorbidity on post-acute outcomes in acquired brain injury: ABI-RESTaRT 1991–2020. Ann Phys Rehabil Med 2022; 66: 101669. doi: 10.1016/ DOI:

Colantonio A, Escobar MD, Chipman M, McLellan B, Austin PC, Mirabella G, Ratcliff G. Predictors of postacute mortality following traumatic brain injury in a seriously injured population. J Trauma 2008; 64: 876–882. doi: 10.1097/TA.0b013e31804d493e DOI:

Blake ML, Duffy JR, Myers PS, Tompkins CA. Prevalence and patterns of right hemisphere cognitive/communicative deficits: retrospective data from an inpatient rehabilitation unit. Aphasiology 2002; 16: 537–547. doi: 10.1080/02687030244000194 DOI:

Australian Human Rights Commission. Older women’s risk of homelessness: background paper. Australian Human Rights Commission 2019. [accessed 2022 Sept 2] Available from:

Talari K, Goyal M. Retrospective studies – utility and caveats. J R Coll Physicians Edinb 2020; 50: 398–402. doi: 10.4997/jrcpe.2020.409 DOI:



How to Cite

Mann, G., Troeung, L., & Martini, A. (2023). Sex/gender differences in service use patterns, clinical outcomes and mortality risk for adults with acquired brain injury: a retrospective cohort study (ABI-RESTART). Journal of Rehabilitation Medicine, 55, jrm5303.



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