Inpatient physical therapy (PT) is a high-intensity form of rehabilitation provided within a medical facility following a serious illness, injury, or major surgery. This structured program is designed to help individuals recover functional abilities lost due to a recent medical event. Patients receive comprehensive, coordinated services from a team of medical and therapeutic professionals. The goal of this intensive treatment is to rapidly improve the patient’s mobility and independence so they can safely transition home or to a less restrictive environment.
Defining Inpatient Physical Therapy
Inpatient physical therapy is medically necessary when a patient is stable enough to leave an acute care hospital but still requires intensive rehabilitation and a high degree of medical oversight. A major consideration for admission is the patient’s “rehabilitation potential,” meaning the patient is expected to make measurable functional improvement within a reasonable timeframe. This care is typically reserved for individuals recovering from events like stroke, major orthopedic procedures, traumatic brain injury, or spinal cord injury.
The patient must require 24-hour nursing supervision and physician oversight, often from a specialized rehabilitation physician called a physiatrist. To qualify, the patient must require active participation in at least two different therapy disciplines, such as physical therapy, occupational therapy, or speech-language pathology. This coordinated, multi-disciplinary approach is a hallmark of inpatient physical therapy, ensuring all aspects of recovery are addressed. The therapy itself must be complex enough to require the skill and judgment of a licensed therapist.
Settings Where Inpatient PT Occurs
Inpatient PT is primarily delivered in two settings: Inpatient Rehabilitation Facilities (IRFs) and Skilled Nursing Facilities (SNFs). IRFs are designed for patients who can tolerate and benefit from the highest intensity of care. These facilities are physician-led, often by a physiatrist who sees the patient multiple times per week, and they maintain a hospital level of care.
Skilled Nursing Facilities provide a lower, but still skilled, level of rehabilitation and nursing care. SNFs are appropriate for patients who may not tolerate the rigorous schedule of an IRF due to medical complexity or fatigue, or whose rehabilitation goals are less intense. The primary distinction is the required intensity of therapy, with IRFs having a much more demanding schedule.
The Structure of Daily Inpatient Therapy
In an Inpatient Rehabilitation Facility, the patient’s day is highly structured around intensive therapy sessions. Patients are typically required to participate in at least three hours of therapy per day, five days a week, or a minimum of 15 hours over a seven-day period. This therapy time is divided between disciplines like physical therapy, which focuses on walking and mobility, and occupational therapy, which addresses daily tasks such as dressing and bathing.
Therapy sessions are generally scheduled in the morning and afternoon, with breaks for meals and rest integrated into the routine. Patients are encouraged to practice learned skills outside of dedicated therapy time, integrating them into daily activities like walking or self-care tasks. A full interdisciplinary team, including therapists, nurses, case managers, and social workers, collaborates daily or weekly to discuss progress and adjust the treatment plan.
Planning for Discharge and Follow-Up Care
Discharge planning begins almost immediately upon the patient’s admission. The goal is to ensure a safe and successful transition to the next level of care and prevent hospital readmission. Physical therapists assess the patient’s functional capacity, including mobility, cognitive status, and self-care abilities, to determine the most appropriate discharge destination.
The planning process involves assessing the patient’s home environment, identifying potential barriers like stairs or narrow doorways, and coordinating any necessary durable medical equipment (DME), such as walkers or shower chairs. Family members and caregivers are actively involved, receiving training from therapists on how to safely assist the patient with mobility and daily tasks. Once inpatient goals are met, the team coordinates the transition to a lower level of care, such as home health services, outpatient physical therapy, or independent living.