Timing and Intensity of Rehabilitation Services During Acute Stroke Hospitalization: Impacts on Functional Recovery...

Improving functional recovery and supporting safe discharge pathways after stroke are key priorities in acute care, yet the delivery of rehabilitation services during hospitalization remains poorly understood.

To examine the associations between rehabilitation service delivery factors and two outcomes, functional status at discharge and community discharge.

Retrospective observational study using electronic medical record (EMR) data (2018-2021). Regression analyses were stratified by occupational therapy (OT) and physical therapy (PT) cohorts.

Thirteen-hospital health system in Colorado.

Adults hospitalized with ischemic stroke who received occupational therapy (n = 713) or physical therapy (n = 979).

Primary outcomes were (1) discharge function using Activity Measure for Post-Acute Care "6-Clicks" scores and (2) community discharge (yes or no). Independent variables included time to evaluation, time to treatment, and daily therapy intensity.

Among OT recipients, each additional day of delay between evaluation and the first therapy session was associated with lower odds of community discharge (odds ratio [OR] = 0.927, p = .032) whereas greater therapy intensity was associated with higher odds (OR = 1.396, p = .034). These same factors were also associated with higher discharge function (p < .05). In the PT model, earlier evaluation was significantly associated with improved discharge mobility (p = .006), although no other therapy factors were significant.

Findings suggest that timely and intensive OT services during acute hospitalization may improve functional outcomes and increase community discharge rates. EMR-derived therapy metrics provide clinically relevant insight and may inform hospital-based rehabilitation strategies. Plain-Language Summary: This study looked at how early and intensive occupational therapy during a hospital stay for stroke affects a person's ability to function and return home. Using hospital records from more than 1,600 patients, the study found that patients who received earlier and more intense OT were more likely to regain independence and go home rather than to a facility. These results suggest that not just receiving therapy but how and when it is delivered plays a big role in recovery. This could help hospitals better support patients during stroke recovery.