Prevalence and factors associated with difficult discharges in outpatient physical therapy: A cross-sectional survey

Outpatient physical therapy often marks the final stage of formal rehabilitation and is punctuated by discharge to community-based wellness or home exercise program. Despite its critical role in care continuity, the outpatient discharge process remains underexplored, specifically those discharges that are more difficult or challenging.

This exploratory study examined the prevalence, contributing factors, and clinician-perceived impact of difficult discharges in outpatient physical therapy to inform early conceptual and operational definition development.

A cross-sectional study was conducted using an Qualtrics survey that incorporated both quantitative and qualitative components. Three hundred and twenty four licensed physical therapists (PTs) practicing in United States (US) outpatient settings who primarily treated adults completed the survey. Quantitative data were analyzed descriptively and with regression modeling to examine clinician and practice characteristics associated with self-reported discharge difficulty, while qualitative responses to four open-ended questions were analyzed thematically to identify recurrent concepts and contextual factors influencing difficult discharges.

The median self-reported prevalence of difficult discharges was 20% (interquartile range [IQR] 10-31%). Physical therapist age was inversely associated with reported discharge difficulty, with younger clinicians (<34-years-old) and those treating neurological populations reporting higher rates and emotional burden. Thematic analysis helped generate a preliminary working definition of the difficult discharge. Six qualitative themes were identified: early communication and education, knowledge gaps, chronic condition complexity, behavioral compliance, financial barriers, and interdisciplinary collaboration. These themes illustrated the multifactorial nature of difficult discharges and their impact on care transitions and clinician well-being.

Difficult discharges are common in outpatient physical therapy and arise from interconnected patient, provider, and system factors. Younger clinicians and those working in neurological practice may experience greater emotional strain. Early, consistent discharge planning and improved support systems may be associated with smoother care transitions and help sustain clinician well-being.