Sex- and Gender-Based Characteristics Influence Responses to a 4-Week Exercise-Based Stroke Telerehabilitation Programme: A Multiple Case Study

Abstract Purpose: Sex- and gender-based factors can act as barriers to stroke recovery. The primary objective of this study was to describe and explore potential sex- and gender-based characteristics that may be associated with the clinical responses of six participants to a 4-week telerehabilitation programme. Method: Using a multiple case study design and purposeful sampling (age and stroke severity), we contrasted and compared responses of three male and three female participants. Participants completed four assessments: pre- and post-intervention, 3- and 6-month follow-ups. Outcome measures were the Stroke Impact Scale-3 (SIS-3), 30-second sit-to-stand (30sSTS) test, and Activity-Specific Balance Confidence Scale. Sex- and gender-based characteristics were reported, and individual trajectories were described. Results: Female participants had more favourable trajectories in emotion, memory and thinking, mobility, participation domains of the SIS-3, and activity-specific balance confidence. Female participants also had sustained improvements in 30sSTS. Stroke type and marital status are among the personal characteristics of female participants that may explain the responses observed. Conclusion: The more favourable trajectories in many domains demonstrated by women could be explained by sex- and gender-based characteristics. Men possessed personal characteristics often associated with poorer functional recovery, contradicting sex- and gender-based disparities generalized to women with stroke.