Relationship Between Urinary Incontinence, Cognition, Ambulation, and Discharge Destination in Acute Traumatic Brain Injury Inpatient Rehabilitation

Research Objectives: To examine if improvement in urinary-incontinence is associated with acute-Traumatic-Brain-Injury (TBI) inpatient-rehabilitation outcomes in cognition, ambulation, and discharge destinations.

Design: Retrospective observational study.

Setting: Inpatient-rehabilitation (IR).

Participants: 12,895 acute-TBI patients admitted to a US-national-rehabilitation-hospital-system 1/1/2015-12/31/2019 with urinary-incontinence (total-assistance or maximal-assistance Functional-Independence-Measure (FIM) scores 0-2 for bladder management).

Interventions: Discharge FIM scores were correlated for continence, cognition- (cognitive-skills-subtotal), ambulation-(walk/wheelchair), and discharge destination (home/community, back to acute-care, or skilled-nursing-facility).

Main Outcome Measures: Comparison at IR discharge of functional outcomes and discharge destinations between patients that remained total-to-moderate-assistance for urinary continence/bladder-management, and those that recovered to minimal-assist to independent for urinary continence/bladder-management.

Results: Patients were part of a larger cohort of 22,911 patients having acute-TBI with 56% being dependent or maximal assistance for bladder control. Of those with urinary incontinence 42% were female and 58% were male with an average age of 72±17.7 years, average length of stay of 15.4±9 days, and a cognitive-skills-subtotal admission FIM score of 14.4±6.5. At discharge 5539 of 12,895 (42.9%) remained urinary incontinent (total or maximal assistance). Continence/bladder-management FIM scores at discharge were associated with cognition FIM scores at discharge (chi square=2480, P<.0001), and walk/wheelchair FIM scores at discharge (chi square=3285, P<.0001).
Continence/bladder-management FIM scores at discharge were also associated with discharge disposition destinations (chi square=1,870; P<.0001). Patients total to moderate assistance for continence at discharge included greater percentage of acute-care transfers (28%), and skilled-nursing-facility dispositions (20.5%), than patients that recovered to minimal assistance to independent for continence with 5.9% being transferred to acute and 9.3% being discharged to a skilled nursing facility. Urinary-incontinence recovery to continence with minimal-assistance to independence was associated with a home/community disposition rate of 84% versus only 49% of those who remained bladder incontinent (dependent or maximal-assistance at discharge).

Conclusions: 56% TBI patients were total to maximal-assistance with bladder management for urinary incontinence on IR admission. Partial to complete continence recovery occurred in 57.1%. Recovery in continence/bladder-management FIM scores was associated with significant improvements in cognition and ambulation FIM scores, and significantly more discharges to home/community.

Author(s) Disclosures: None.