“Is gender-specific differentiation required in patients after total hip or knee replacement surgery at the beginning of inpatient rehabilitation?”
This study was conducted at the Rehabilitation Clinic Montafon under the direction of Univ.-Doz. Dr. Thomas Bochdansky.
The “International Classification of Functioning, Disability, and Health (ICF)” of the World Health Organization provides a globally uniform assessment of the possibilities and abilities of patients in rehabilitation. Internationally, muscle function is tested using the Timed-Up-and-Go test (TUAG); pain, by means of the visual analogue scale (VAS).
The gender of a person is one of the fundamental individual, “endogenous” determinants that must be taken into account in the context of the ICF model whenever an individualized rehabilitation plan is to be created. In addition, the other “domains” such as bodily function and body structure, activity and participation, as well as “external” context factors, must also be analyzed and evaluated, of course.
The aim of our study was to examine whether gender specificity can be derived from our data, which would ultimately entail gender-specific rehabilitation planning. Here we analyzed the routinely collected data from the rehabilitation clinic Montafon.
The specific question to be addressed here was how in two specific groups patient undergoing large-joint surgery (knee and hip) the determinant “gender” is correlated with other results in the assessment of the functional and activity spectrum at the beginning of inpatient rehabilitation.
A total of 671 male and female patients were examined after elective hip or knee joint replacement in the period from May 2013 to April 2014. These comprised 385 knee surgery patients (149 men, 236 women) and 286 hip surgery patients (145 men, 141 women). Inpatient rehabilitation started on average three weeks after surgery. During the first two days of the hospitalization, the first WOMAC questionnaire was completed by the patient, the pain level queried, and the first TUAG test performed.
In women, after both types of surgery there was a significantly higher risk of falling than there was in men.
This means: In rehabilitation, women need more strength-training units, and more intensive balancing training. This is relevant also for a very female-specific topic such as osteoporosis as concomitant disease.
“Gender-specific aspects in neurorehabilitation after stroke”
This study was conducted in cooperation between the Neurological Therapy Center Gmunderberg and the Gender Medicine Unit of the Medical University of Vienna under the leadership of Prim. Dr. Hermann Moser.
A retrospective analysis of the data of 1593 male and female stroke patients who underwent rehabilitation treatment at VAMED’s Neurological Therapy Center Gmundnerberg between 2010 and 2015 was conducted in the context of a first cooperation project of the Neurological Therapy Center Gmundnerberg and the Gender Medicine Unit of the Medical University of Vienna. The aim was to identify gender-specific aspects in neurorehabilitation and, if possible, to improve treatment in a gender-specific manner.
In summary, the evaluation showed significantly lower Barthel indices (assessment of the patient’s abilities of daily life) in women upon admission, which is also the cause of poorer outcome.
Female gender had an influence on the presence of depression, pain, and the Barthel index. Women report pain more frequently and subjectively report greater more severe pain upon admission. Gender in itself, however, had no effect on the rehabilitation effect. This means that men and women benefit equally from rehabilitation.
Men are more likely to suffer from type-2 diabetes, hypertension, and cardiac disease upon admission, while women exhibit more frequently osteoporosis, depression, and pain symptoms.
Regarding the risk factors of smoking and atrial fibrillation, there were no differences.
The improvement in general condition depended on the patient’s condition, age and presence of type-2 diabetes upon admission, and on the period elapsed up to the beginning of neurorehabilitation after the stroke.
It can be concluded that neurorehabilitation should be initiated as quickly as possible, and especially in women the simultaneous presence of depression and pain or sufficient analgesic treatment, respectively, must be taken into account.
This project was presented to and honored by the Austrian Society for Gender-Specific Medicine in 2017.