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Impact of Therapist-Led Ward-Based Interprofessional Management on ADL Gains: A 3-Way Interaction With Rehabilitation
Kouhei Yasuda1, Masaaki Matoba2, Yumi Kamijo2
1Department of Medical Basics, Specialty and Education, Graduate School of Health Sciences, Showa Medical University, Yokohama, Kanagawa, Japan; Department of Tokyo Physical Therapy, Faculty of Medical Sciences, Teikyo University of Science, Adachi, Tokyo, Japan.
Objectives:
Functional decline during acute-care hospitalization is a critical challenge. While rehabilitation volume influences recovery, the role of organizational factors is less defined. We examined whether therapist-led ward-based management modifies the association between conventional rehabilitation volume and activities of daily living (ADL) gain.
Design:
Multicenter retrospective observational cohort study.
Setting And Participants:
Data from 4166 consecutive patients across 18 acute-care wards in 9 Japanese hospitals.
Methods:
The primary outcome was ADL gain (Barthel Index change from admission to discharge). Ordinary least squares regression models with mean-centered continuous variables were employed to evaluate interaction patterns while adjusting for age, admission Barthel Index, and ward-level average length of stay per clinical specialty. We investigated the independent main effects, 2-way interactions, and the 3-way interaction among therapist-led ward management, weekday rehabilitation volume, and weekend rehabilitation volume.
Results:
While the main effect of ward management was not significant (P = .390), a significant positive 2-way interaction emerged between management and weekend rehabilitation volume (β = 0.968; P = .021). Furthermore, a significant 3-way interaction was observed among management, weekday, and weekend rehabilitation volume (β = 0.186; P = .005), with all variance inflation factors for interaction terms ≤5.05.
Conclusions And Implications:
Therapist-led ward management was not independently associated with ADL gain; however, significant interaction patterns were observed with weekday and weekend rehabilitation volume. In particular, the interaction with weekend rehabilitation volume suggests that ward-based management may support more consistent rehabilitation delivery across the week. These findings suggest that organizational ward-based management may influence how rehabilitation exposure is associated with functional recovery during acute-care hospitalization. Organizational strategies emphasizing structured interdisciplinary integration, rather than solely increasing therapy volume, may help support functional outcomes in hospitalized older adults.
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