Effect of High-Intensity Gait Training in the Acute Care Setting on Length of Stay and Functional Status in Patients with Stroke

Background/Objectives: The feasibility of high-intensity gait training (HIGT) in the acute care setting has only been demonstrated in two studies and its impact on functional status and length of stay (LOS) is not clear. The purpose of the present study was to further examine the impact of HIGT on acute care LOS and change in Activity Measurement for post-acute care (AM-PAC 6-Clicks). Methods: This was a retrospective medical record review of a cohort of patients in the acute care setting who received HIGT following implementation of a quality improvement project. Historical conventional care patients were identified and matched to the HIGT group using propensity score matching. Linear mixed models were used to examine the effect of group on acute care LOS and change in AM-PAC 6-Clicks. Results: 36 HIGT patients with one matched control and 22 with two matched controls were analyzed. After controlling for unbalanced covariates using a linear mixed model, acute care LOS was 1.2 days shorter in the HIGT group compared to the conventional care control group (p = 0.031, 95% CI 0.11, 2.29). There was no difference in change in AM-PAC 6-Clicks (p = 0.575, 95% CI −1.36, 0.76). Conclusions: Receiving HIGT in the acute care setting was associated with a 1.2-day-shorter LOS compared to conventional care in this study cohort; however, exposure to HIGT does not appear to improve the functional status during acute hospitalization post-stroke in this cohort. The mechanism underlying the association with the shorter LOS remains unclear and may reflect increased confidence in the patient’s readiness for discharge, unmeasured differences between cohorts, or changes in a variety of factors that influence discharge disposition given the cohorts were from two different time periods.