Functional gains and therapy intensity during subacute rehabilitation: A study of 20 facilities

Objectives: To document patient, program characteristics, and therapy service provision in subacute rehabilitation across 3 types of facilities that provide subacute rehabilitation, to examine the determinants of therapy intensity, and to evaluate the contribution of rehabilitation services to functional gains. Design: A retrospective study linking administrative billing data and patients' functional assessment records. Setting: Twenty facilities part of the Uniform Data System for Medical Rehabilitation (UDSMR) subacute database Participants: A total of 1976 billing records of patients with stroke, orthopedic, and debility impairments, discharged in 1996 and 1997, were retrieved and linked with the FIM(TM) instrument ratings from UDSMR subacute database. Interventions: Not applicable. Main Outcomes Measures: Total therapy intensity and Rasch-transformed FIM domain gains (ie, gains in self-care, mobility, cognition). Results: Therapy intensity was mostly determined by impairment and facility type, although variances explained by the predictors were small. Patients in all 3 impairment groups made functional gains; gains were related weakly, although significantly, to therapy intensity and rehabilitation duration after controlling for other variables. Conclusions: The provision of rehabilitation therapies varied across facilities. Skilled nursing facilities with subacute rehabilitation units tended to provide more therapies than subacute units in acute or rehabilitation hospitals.