This study examined patterns in physical (PT) and occupational therapy (OT) recommendations for post-acute rehabilitation during an acute stroke hospitalization.

Discharge planning during an acute stroke hospitalization is complex. The initial PT and OT recommendations often initiate discharge planning, making this a critical decision point, but this process is poorly understood.

This cohort study included adults who were hospitalized for an ischemic or hemorrhagic stroke within a large academic health system from January 1, 2018– December 31, 2024. All demographic and clinical data were extracted from the electronic health record. Kappa scores examined agreement between the PT and OT initial and final discharge recommendations. A generalized logistic regression evaluated factors associated with a change in the discharge recommendation during the acute admission.

The cohort comprised 10,684 hospitalizations with a mean age of 68.6 years. There was almost perfect agreement between the initial PT and OT discharge recommendations (κ = 0.86), and the final recommendation (κ = 0.86). The initial PT and OT recommendations were unchanged from evaluation to discharge for 6478 (60.6%) of cases. Discharge to an inpatient rehabilitation facility was the most common disposition at both time points. The strongest associations with a change in the PT/OT discharge recommendation were a longer hospital admission, hemorrhagic stroke, ICU admission, physiatry consultation, and a higher AM-PAC activities of daily living score.

Although many patients typically improve to varying degrees during a stroke hospitalization, PT and OT recommendations for discharge rarely change. Future work can investigate if patients discharge to where they were recommended to go, and how longer-term outcomes may vary by those whose recommendations changed during the admission versus those who did not change.