Patients with stroke may make more functional gains if their postacute care includes treatment received at an inpatient rehabilitation facility (IRF), say authors of an article published this month in Archives of Physical Medicine and Rehabilitation. This finding may have important implications as postacute care delivery is reshaped through health care reform, they add.

Researchers conducted this prospective cohort study at 4 northern California hospitals that are part of a single health maintenance organization. They enrolled patients with stroke (N=222) between February 2008 and July 2010.

Baseline and 6-month assessments were performed using the Activity Measure for Post Acute Care (AM-PAC), a test of self-reported function in 3 domains: basic mobility, daily activities, and applied cognition.

Of the 222 patients analyzed, 36% went home with no treatment, 22% received home health/outpatient care, 30% included an IRF in their care trajectory, and 13% included a skilled nursing facility (but not IRF) in their care trajectory. At 6 months, after controlling for variables such as age, functional status at acute care discharge, and total hours of rehabilitation, patients who went to an IRF had functional scores that were at least 8 points higher (twice the minimally detectable change for the AM-PAC) than those who went to a skilled nursing facility in all 3 domains and in 2 of 3 functional domains compared with those who received home health/outpatient care.

APTA members Alan Jette, PT, PhD, FAPTA, Diane E. Brandt, PT, PhD, and Elizabeth K. Rasch, PT, PhD, coauthored the article.