Implementing High Intensity Home-Based Rehabilitation Following Stroke: A Descriptive Study

Abstract

<h3>Research Objectives</h3> To describe the implementation of a novel high intensity home-based rehabilitation (HIHR) program for a subgroup of patients with stroke. <h3>Design</h3> A descriptive study of the adoption of HIHR, including observed process measures and patient outcomes. <h3>Setting</h3> One hospital and homecare agency. <h3>Participants</h3> Clinical eligibility criteria for HIHR are: ischemic or hemorrhagic stroke, NIH Stroke Scale score ≤10, AM-PAC 6-Clicks mobility score 17-22, readmission risk ≤35%, and a subjectively determined level of appropriate caregiver support at home. We included records for patients discharged to HIHR October 2021 through February 2022. <h3>Interventions</h3> Primary interventions for HIHR include (1) identification of eligible patients in the hospital; (2) high frequency of physical, occupational, and/or speech therapy at home over a shorter episode relative to traditional homecare; and (3) a weekly interdisciplinary care coordination meeting. <h3>Main Outcome Measures</h3> Adoption was measured as the number discharged to HIHR relative to the number eligible. Process measures were episode length and the number of completed therapy visits. The primary patient outcome was functional status at HIHR discharge according to the mobility subsection score of the Continuity Assessment Record and Evaluation (CARE) tool, which ranges 15 (low function) to 90 (high function). <h3>Results</h3> Of 94 eligible patients, 26 (27.7%) discharged to HIHR. Other eligible patients discharged primarily to an inpatient rehabilitation facility (23.4%) or traditional homecare (21.3%). The median (IQR) length of HIHR episodes was 20.5 (17-27) days. Median visit counts by discipline were 4 (2-5) for occupational therapy, 6 (3-7) for physical therapy, and 4 (0-7) for speech therapy. The median CARE mobility score at HIHR discharge was 80 (51-88). <h3>Conclusions</h3> High intensity home-based rehabilitation can be implemented for a subgroup of patients with stroke. Patients had acceptable functional outcomes. The relatively low adoption we observed indicates an opportunity to refine HIHR inclusion criteria and/or to address gaps in hospital discharge planning communication. Future research should compare HIHR to traditional post-acute care and enable optimal matching of therapy service intensity in HIHR to patients' specific rehabilitation needs. <h3>Author(s) Disclosures</h3> No conflicts of interest.