To determine whether implementing twice-daily (BID) inpatient physical therapy (PT) improves outcomes compared with standard 3–5 sessions per week for patients hospitalized with acute stroke

The optimal inpatient PT approach after stroke remains unclear; frequency, intensity, and timing are not well defined. Very early, high-intensity therapy may be poorly tolerated, whereas shorter, more frequent sessions could enhance participation and functional outcomes without added risk. Current AHA/ASA guidance does not mandate a uniform PT frequency. To address this gap, our center introduced a service-level shift to twice-daily PT (BID-FAST/ BID-Frequency Augmented Stroke Therapy) during acute stroke hospitalization

Retrospective pre–post cohort study at a comprehensive stroke center across two four-month periods. The pre-implementation cohort received standard-frequency PT (3–5 sessions/week), and the post-implementation cohort received twice-daily PT (BID-FAST). Outcomes were hospital length of stay (LOS), discharge disposition, and discharge modified Rankin Scale (mRS). Between-group comparisons used Welch’s t and Fisher’s exact tests with 95% confidence intervals

Among 296 patients (standard n=155; BID-FAST n=141), mean LOS decreased from 6.83 to 4.61 days after BID-FAST implementation (difference 2.22 days; 95% CI 0.57–3.87; p=0.0086). Discharge mRS was similar between cohorts (2.13 vs 2.07; p=0.777). The proportion discharged home increased from 56.1% (87/155) to 58.2% (82/141) (difference +2.0 percentage points; 95% CI −9.3 to +13.3; p=0.814)

Implementing twice-daily inpatient PT for acute stroke was associated with a clinically and statistically significant reduction in hospital length of stay, with no detectable worsening in discharge function or disposition. These findings support therapy frequency as a modifiable component of acute stroke rehabilitation and motivate prospective studies to test causality and quantify effects on disability and discharge destination