Skilled nursing facility rehabilitation and discharge to home after stroke

Objective — To determine the relation between rehabilitation therapy (RT) intensity and time to discharge home for stroke patients in skilled nursing facilities (SNFs).

Design — Retrospective cohort study. We used regression analyses, stratified by expected outcome, and propensity score adjustment.

Setting — All SNFs in Ohio, Michigan, and Ontario, Canada.

Participants — A cohort of residents, aged 65 and over, admitted from hospitals to SNFs with a diagnosis of stroke (N=23,824).

Interventions — Not applicable.

Main Outcome Measure — Time to discharge home from an SNF.

Results — RT was given to more than 95% of residents for whom discharge was expected within 90 days and to more than 60% of residents for whom discharge was uncertain or not expected. RT increased the likelihood of discharge to the community for all groups except those expected to be discharged within 30 days. The dose-response relation was strongest for residents with either an uncertain discharge prognosis or no discharge expected.

Conclusions — Postacute residents with an uncertain prognosis are an important target population for intensive RT.