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Application of Bedside Lower Extremity Rehabilitation Robots in Stroke Rehabilitation: A Randomized Controlled Trial
Published on: November 28, 2025
The Comparative Effectiveness of Inpatient Versus Skilled Nursing Facility Rehabilitation Using Linked Acute Stroke
Raed Hailat1, Michael P Thompson2, J Adam Oostema3
1Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI.
Objectives:
To examine the comparative effectiveness of rehabilitation at inpatient rehabilitation facilities (IRFs) versus skilled nursing facilities (SNFs) on home time-a proxy of functional recovery among patients with acute stroke.
Design:
A retrospective comparative effectiveness cohort of hospitalized acute stroke (International Classification of Disease-10 I61-I63) cases identified by the Michigan Stroke Registry and probabilistically linked to Medicare fee-for-service (FFS) data. We quantified the comparative effectiveness of IRF versus SNF using inverse probability treatment weighted multivariable linear models.
Setting:
IRF and SNF admissions from 31 registry hospitals between 2016 and 2020.
Participants:
FFS Medicare patients with acute stroke.
Interventions:
Not applicable.
Main Outcome Measures:
Ninety-day and 1-year home time (number of days alive and outside of inpatient care) calculated at 2 different starting points: from the time of discharge from acute hospital care (traditional home time) or the time of discharge from IRF or SNF care (referred to as amended home time).
Results:
We identified 5943 hospitalized Medicare FFS beneficiaries discharged to IRF (n=2995) or SNF (n=2948). After inverse probability treatment weighted adjustment, the mean traditional home time for patients in IRF was 11.1 days (95% confidence interval [CI], 9.5-12.57) longer at 90 days, and 46.3 days (95% CI, 39.8-52.9) longer at 1 year, compared with patients in SNF. However, when amended home time was used, the mean difference in 90-day home time disappeared (0.5d; 95% CI, -1.1 to 2.1) but remained significant at 1 year (35.7d; 95% CI, 29.1-42.2).
Conclusions:
IRF care was associated with longer traditional home time both at 90 days and 1 year. However, amended home time showed that the difference at 90 days was explained by the longer length of stay at SNF facilities. Future studies should avoid using traditional home time as a means of comparing patient outcomes between IRF and SNF settings.
