When confronting the need for rehabilitation or therapeutic services, understanding the core features of and differences between inpatient therapy services and outpatient therapy services is critical. Beginning the recovery journey can be intimidating and both inpatient and outpatient therapy offer essential services. By educating patients, providers and families on the primary features of these different therapy settings, therapists help patients navigate the stages of treatment and rehabilitation. We enlisted the expertise of Kelly Voltz, OP PT, and Karaline Hallett, IP OT, Parkview Hospital Randallia, to outline these offerings.
What are the core features of the inpatient rehabilitation program?
When a patient is admitted to an inpatient rehabilitation program, they are expected to participate in intensive therapy, typically for at least three hours for five to seven days each week. The program focuses on functional outcomes with the goal of safely discharging the patient so they can return home.
Another core feature of the inpatient rehabilitation program is the ability of a multidisciplinary group of team members to work together to achieve a patient’s goals. Doctors, nurses, occupational therapists, physical therapists, speech therapists, case managers and other team members work together to help each patient develop and execute a personalized treatment plan.
Because inpatient programs allow for 24/7 medical and nursing care, patients are monitored continuously, which enables the treatment plans to be updated based on the patient’s status. Additionally, patients and family members receive personalized education on the patient’s diagnosis, the level of assistance the patient may require upon discharge, and recommendations for further therapy services and equipment needs.
What therapies and services are available to patients in the inpatient setting?
Inpatient therapy patients have access to services from consulting physicians, in addition to occupational, physical and speech therapy. Patients may also receive services from respiratory therapy, mental health professionals, nutritional and dietary services, recreational therapy, etc.
Each patient receives a range of services tailored to his or her recovery needs. Therapy services in an inpatient setting include but are not limited to:
- Initial evaluation and assessment
- Developing treatment plans in partnership with the patient
- Cognitive and perceptual therapy
- Specialized return to walking with the use of various machines/devices
- Therapeutic exercise programs
- Specialized discharge planning
- Return to driving evaluations
- Practice for activities of daily living (ADLs) and instrumental activities of daily living (IADLs)
- Cognitive and perceptual training
- Gait and balance training
- Vestibular training
- Pain management
- Manual therapy
- Ergonomic and posture training
- Transfer training
- Education and training on use of assistive devices
- Neurological rehabilitation
- Speech therapy
- Swallowing interventions
- Adaptive equipment training
- Home modification recommendations
- Neurological rehabilitation
- Education and preventative care
- Modalities including electrical stimulation
What are the main features of the outpatient rehabilitation program?
Patients referred to outpatient therapy have various diagnoses and come into the clinic while living at home, which permits more flexible scheduling.
In the outpatient setting, therapists address the deficits which limit a patient’s ability to independently live at home and participate in meaningful activities. Patients work on a variety of skills in an outpatient setting, from mobility, strengthening and endurance with physical therapy, to self-care skills, upper extremity function, and functional cognitive skills with occupational therapy, to speech, swallowing and cognition with speech therapy. The goal is to help a patient regain their previous level of function.
What therapies and services are available to patients in the outpatient setting?
The outpatient setting offers services from occupational, physical and speech therapy, including but is not limited to:
- Initial evaluation and assessment
- Development of Treatment plans in partnership with the patient
- Specialized return to walking with the use of various machines/devices
- Modalities including electrical stimulation, dry needling, cupping, blood flow restriction
- Grip/pinch training
- Hand therapy
- Speech therapy
- Swallowing interventions
- Adaptive equipment training
- Environmental modification
- Sensory integration
- Custom splinting and orthotic management
- Return to driving evaluations
- Training for activities of daily living (ADLs) and instrumental activities of daily living (IADLs) in a realistic environment with kitchen, bed, laundry and other household supplies
- Gait and balance training
- Vestibular training
- Pain management
- Therapeutic exercise programs
- Manual therapy
- Ergonomic and posture training
- Neurological rehabilitation
- Cognitive and perceptual training
- Education and preventative care
What are the primary advantages of inpatient rehabilitation for patients?
The primary advantage of inpatient rehabilitation is having 24/7 supervision and care. Some patients benefit from participating in intensive therapy, three hours per day, to better help them return to their baseline level of functioning. Having a strong multidisciplinary approach is also a benefit. Doctors, nurses, therapists and case management consistently communicate and plan for a patient’s discharge together to work towards a successful outcome.
What are the primary advantages of outpatient rehabilitation for patients?
In outpatient therapy, therapists can cater/modify interventions in the clinic to address their specific needs. Because the patient is coming from home, they or family members can provide information on specific barriers the patient is experiencing. Additionally, a variety of modalities are also available in the outpatient setting which may not be as readily available in an inpatient setting.
What makes a patient a strong candidate for inpatient rehabilitation?
When a patient is being evaluated by occupational, physical or speech therapy in an acute care setting, those who can tolerate three hours of therapy a day but still need 24/7 medical support for their acute medical needs are the primary candidates for inpatient rehabilitation. Other patients best suited for inpatient rehabilitation include those with orthopedic or neurological conditions that have recently presented barriers to the patient's ability to complete functional activities at home.
The most common diagnoses in inpatient rehabilitation include:
- Neurological conditions (stroke, brain injury, spinal cord injury, neuropathy, peripheral nerve injury, Guillain Barre, multiple sclerosis, Parkinson’s disease)
- Orthopedic conditions (hip fractures, amputations, polyarthritis, and severe or advanced osteoarthritis)
Inpatient rehabilitation is particularly beneficial to patients with these deficits because it provides them with intensive therapy immediately after experiencing a decrease in function. Inpatient therapy is also beneficial for patients who have limited caregiver or family support, or who require continued medical care from various providers.
Which patients benefit most from outpatient rehabilitation?
Patients who are medically stable as well as patients who have reliable transportation and can consistently arrive for appointments are the best candidates for outpatient therapy services.
The outpatient setting allows the patient to trial their daily routine in the comfort of their own home and then bring their struggles to their therapist where they can troubleshoot and develop a solution together. Working with a patient in the clinic ensures that patients can then return home and immediately initiate the interventions that they worked on in therapy. This trial-and-error method would be more difficult to accomplish in an inpatient setting.
Some examples of outpatient therapy scenarios include:
- Regaining the ability to use an arm as a stabilizer after having a stroke or brain injury.
- Moving the shoulder again or reach into a cabinet to return to cooking following a total shoulder or rotator cuff tear repair.
- A return to tennis, golf or a favorite activity after a hand injury.
- Following a brain tumor resection surgery, facilitating a patient’s ability to reach for a target, grasp and move it to where the patient intends to drop it to get back to daily domestic tasks.
What do people get wrong about inpatient vs. outpatient therapy services?
Misconception No. 1: There is no difference between physical therapy and occupational therapy.
Some patients even believe that these services are interchangeable, but occupational and physical therapists focus and specialize in different aspects of rehabilitation. For example, physical therapists are more specialized in gait training, LE strengthening, vestibular therapy, etc., while occupational therapists focus more on activities of daily living, cognition, etc. Patient outcomes are better when multiple disciplines work together and bring their expertise to the table.
Misconception No. 2: You can stay on the inpatient rehabilitation unit until you are back to normal.
The average stay on an inpatient rehabilitation unit is 12.4 days according to the Center for Medicare Advocacy. Most patients are only approved by insurance to stay until they are functionally safe to return home. Or, if they require further inpatient care, they may be discharged to a nursing facility following their inpatient stay. The goal of inpatient rehabilitation programs is to provide intensive therapy to get patients home safely and quickly.
Learn more about Parkview Therapy Services here.
