Physical Therapy and Occupational Therapy in Acute Care

Abstract

IMPORTANCE: Reducing 30-day hospital readmission rates after ischemic stroke is a national priority, yet optimal rehabilitation service delivery strategies in acute care are unclear. Physical therapy and occupational therapy are essential for functional recovery, discharge planning, and readmission prevention, but the association between service delivery factors and readmission risk remains uncertain.

OBJECTIVE: The objective was to evaluate the relationship between the timing and frequency of physical therapy and occupational therapy in acute care and 30-day readmission rates among patients with ischemic stroke.

DESIGN: This was an observational cross-sectional study using electronic medical records from January 2018 to December 2021.

SETTING: The study was conducted within a 13-hospital health system in Colorado.

PARTICIPANTS: Patients with a primary diagnosis of ischemic stroke (N = 1545) were included. Inclusion required receiving physical therapist or occupational therapist treatment, while exclusions included evaluation-only visits, discharge to hospice, leaving against medical advice, interhospital transfers, or death within 30 days. Final samples included 979 physical therapy and 713 occupational therapy patients, stratified by discharge destination (home vs postacute rehabilitation).

EXPOSURES: Rehabilitation service delivery factors were: (1) time to evaluation: days from admission to first therapy evaluation; (2) time to treatment: days from evaluation to first therapy session; and (3) therapy frequency: total number of therapy sessions (1-2, 3-4, or ≥ 5). Separate analyses were conducted for physical therapist and occupational therapist services.

MAIN OUTCOMES: The primary outcome was 30-day hospital readmission.

RESULTS: Among patients discharged home, fewer days between physical therapist evaluation and treatment were associated with reduced odds of readmission (OR = 1.105, 95% CI = 1.003-1.217). Higher occupational therapy session frequency was linked to lower readmission odds (≥5 sessions: OR = 0.17, 95% CI = 0.029-0.994). After adjustment for length of stay, the association between occupational therapy frequency and readmission was attenuated, whereas the association between time to physical therapy evaluation and readmission remained significant. No significant associations were found in patients discharged to postacute rehabilitation facilities.

CONCLUSIONS AND RELEVANCE: Early physical therapist treatment and frequent occupational therapy sessions were associated with reduced 30-day readmission risk for patients discharged home. Optimizing acute care rehabilitation service delivery is essential to improving postdischarge outcomes.