The relation between therapy intensity and outcomes of rehabilitation in skilled nursing facilities

Objective: To examine the relation between therapy intensity, including physical therapy (PT), occupational therapy (OT), and speech and language therapy (SLT), provided in a skilled nursing facility (SNF) setting and patients' outcomes as measured by length of stay (LOS) and stage of functional independence as measured by the FIM instrument. Design: A retrospective analysis of secondary data from an administrative dataset compiled and owned by SeniorMetrix Inc. Setting: Seventy SNFs under contract with SeniorMetrix health plan clients. Participants: Patients with stroke, orthopedic conditions, and cardiovascular and pulmonary conditions (N = 4988) covered by Medicare+Choice plans, and admitted to an SNF in 2002. Interventions: Not applicable. Main Outcomes Measures: LOS and improvement in stage of independence in the mobility, activities of daily living (ADLs), and executive control domains of function as determined by the FIM instrument. Results: Higher therapy intensity was associated with shorter LOS (P < .05). Higher PT and OT intensities were associated with greater odds of improving by at least I stage in mobility and ADL functional independence across each condition (P < .05). The OT intensity was associated with an improved executive control stage for patients with stroke, and PT and OT intensities were associated with improved executive control stage for patients with cardiovascular and pulmonary conditions (P < .05). The SLT intensity was associated with improved motor and executive control functional stages for patients with stroke (P < .05). Therapy intensities accounted for small proportions of model variances in all outcomes. Conclusions: Higher therapy intensity was associated with better outcomes as they relate to LOS and functional improvement for patients who have stroke, orthopedic conditions, and cardiovascular and pulmonary conditions and are receiving rehabilitation in the SNF setting. (C) 2005 by American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation.