Home-based Rehabilitation After Inpatient Rehabilitation: Utilization Rate and Characteristics of Referred Patients

Objective: To determine the utilization rate of a home-based rehabilitation program after an inpatient rehabilitation stay, and to investigate the profile of users. Design: Observational study. Setting: Inpatient rehabilitation facility in a tertiary hospital. Participants: Older patients (N=1913) discharged home between June 2018 and May 2021, after an inpatient rehabilitation stay. Interventions: Not applicable. Main Outcome Measures: Discharge to home-based rehabilitation. Results: Over the study period, 296 (15.5%) patients were discharged to home-based rehabilitation. Compared with the others, home-based rehabilitation patients were more frequently women (69.6% vs 61.5%; P =.008), and admitted after orthopedic surgery (elective or for fracture) (30.1% vs 16.1%; P <.001). They had worse functional performance at admission (mean Functional Independence Measure self-care score: 27.8 +/- 7.3 vs 30.8 +/- 6.7; P <.001), but greater gain in self-care during their inpatient stay (5.0 +/- 4.8 vs 4.4 +/- 4.7; P =.038). In multivariable analysis, being a woman (adjusted odds ratio [adjOR], 1.36; 95% confidence interval [CI], 1.01-1.82; P =.040), being admitted after orthopedic surgery (adjOR, 2.32; 95% CI, 1.64-3.27; P <.001), being admitted for gait disorders or falls (adjOR, 1.38; 95% CI, 1.01-1.88; P =.039), and showing greater gain in mobility during the inpatient stay (adjOR, 1.12; 95% CI, 1.07-1.17; P <.001) remained associated with discharge to home-based rehabilitation. In contrast, higher mobility at discharge decreased the odds of discharge to home-based rehabilitation (adjOR, 0.87; 95% CI, 0.83-0.91; P <.001). Conclusions: One in 6 patients benefited from home-based rehabilitation after their inpatient stay. Although these patients had poorer functional performance at admission and discharge, they showed greater mobility improvement during their inpatient stay, suggesting that their good recovery potential was a key determinant of their orientation toward home-based rehabilitation. Archives of Physical Medicine and Rehabilitation 2024;105:2135-41 (c) 2024 by the American Congress of Rehabilitation Medicine. Published by Elsevier Inc. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/)