Benefits of Specialized Subacute Stroke Rehabilitation in a Skilled Nursing Facility: Comparison to Nationwide Outcomes

Research Objectives: To characterize the benefits of specialized, multi-disciplinary, neuro-intensive rehabilitation provided to individuals with stroke in a Skilled Nursing Facility (SNF) evaluating change in Minimum Data Set (MDS) functional outcomes and discharge location. A descriptive comparison to national SNF data for individuals with stroke reported by the American Physical Therapy and American Occupational Therapy Association’s “Therapy Outcomes in Post-Acute Care Settings” (TOPS) study is presented.

Design: Retrospective chart review using electronic medical records and MDS data.

Setting: SNF specializing in transitional rehabilitation for complex neurologic diagnoses.

Participants: 207 adults 21-92 years with an ICD-10 stroke diagnosis admitted after 1/1/18 and discharged before 3/14/20.

Interventions: N/A

Main Outcome Measures: Discharge location and MDS G-codes: dressing, bathing, walking/locomotion (average of on and off unit walking), transferring, toileting, and feeding. Scores were inverted and multiplied by 1.5 to allow comparison to the TOPS data.

Results: Paired t-tests compared admission to discharge MDS change with an average gain of 8.2 points (95% CI 7.15-9.24) and average length of stay (LOS) of 9.38 weeks (95% CI 8.74-10.02). The top 34% of responders gained an average of 17.5 points. Several variables (age, sex, LOS, case mix index, therapy minutes, admission time post onset) correlated to improvements measured by the G-code change and discharge location, however, the correlations were weak (r=0.154-0.266, p<.001-.027) and explained little of the variability. Age had the strongest correlation (r=0.266). 84% of individuals discharged to a community setting.
Intensity cannot be directly compared to the TOPS study as total hours of therapy were reported but LOS was not. TOPS reported an average 3.27 point gain for moderate (29.6 to 39 hours) and 3.09 point gain for high intensity (128 to 219.3 hours) interventions, which were 2.5 times less than average gains for our SNF patients.

Conclusions: A preliminary comparison to the TOPS study indicates potential superiority in functional improvement for individuals cared for in a specialized neuro-intensive rehabilitation program in a SNF. Identification of rehabilitation factors and patient characteristics of high responders is needed.

Author(s) Disclosures: None.