What Is the Optimal Length of Stay for Effective Inpatient Neurorehabilitation? A Retrospective Cohort Study

The length of stay (LOS) in inpatient rehabilitation varies significantly and remains ambiguous. Therefore, we sought to determine the optimal length of inpatient rehabilitation.

This retrospective cohort study was conducted at a specialized inpatient rehabilitation hospital. Clinical data from 258 patients with neurological disorders, including stroke, spinal cord injury, and multiple sclerosis, were collected and analyzed. The primary outcome measure was the change in patients' functional status as assessed by the Functional Independence Measure (FIM). FIM scores were recorded at 21-day intervals throughout the hospitalization period. To evaluate the effectiveness of inpatient rehabilitation over time, trends in FIM score changes were examined using effect size calculations. Additionally, Generalized Estimating Equations (GEE) were employed to analyze repeated measures and account for intra-subject correlations across the different time points.

In spinal cord injury (SCI) survivors, the trend of improvement continued with significant effectiveness:1.847 (95% CI: 1.445, 2.249), 3.320 (95% CI: 2.495, 4.144) and 3.036 (95% CI: 1.426, 4.645) during the first, second and discharge assessments, respectively, compared to Admission time. Patients with multiple sclerosis (MS) shown significant effectiveness only during the first 21-day period: 1.276 (95% CI: 0.723, 1.830). Stroke survivors also showed significantly improved their FIM over the three 21-day periods: first period:1.637 (95% CI: 1.284, 1.990), second period: 2.952 (95% CI: 2.106, 3.802), and discharge:3.804 (95% CI: 2.944, 4.668).

LOS exceeding 42 days resulted in a significant increase in the FIM scores of stroke patients. However, an extended stay of 21 days in the MS group and 42 days in the SCI group did not demonstrate significant improvement.