The impact of continued inpatient therapies on functional recovery and community discharge in patients with acquired brain injury

Introduction: Inpatient rehabilitation (IRF) is beneficial for patients with acquired brain injuries (ABI), yet some require ongoing therapy at a skilled nursing facility (SNF). While previous research has examined factors influencing community discharge from SNFs, no studies have specifically evaluated ABI patients admitted to SNFs after IRF stays. The aims of this study are to evaluate functional improvements of acquired brain injury patients undergoing rehabilitation at SNF after an IRF stay and determine factors associated with community discharge. Methods: This is a retrospective cohort study at a SNF unit specialized in brain injury patients and affiliated with an academic medical center. It included patients admitted to a SNF unit from an acute IRF between September 2018 to May 2024, age 18 years or older, with an ABI. The main outcome measures included AM-PAC (Basic Mobility, Daily Activity, and Applied Cognitive) scores and a multivariate analysis of factors associated with community discharge. Results: Among 218 patients with ABI admitted to SNF, 191 (88%) were discharged to the community and 27 (12%) to long-term care (LTC). Mean AM-PAC scores improved across the entire sample in all subdomains. Patients discharged to LTC had a longer length of stay, time since injury, and lower AM-PAC scores. Admission Basic Mobility scores and a diagnosis of ischemic stroke were predictors of community discharge. Discussion: Patients with ABI admitted to SNF following an IRF demonstrate significant functional progress, with most patients discharged to the community. Admission functional scores and diagnosis are key factors associated with community discharge.