After rehabilitation for brain injury, clinical need was not the dominant influence on whether older adults received community therapy

A cohort study using US Medicare claims and assessment data followed 23,036 community-dwelling older adults who received inpatient rehabilitation for traumatic brain injury between 2020 and 2022 Primary Study (Kinney et al., PMID 42870188). It asked whether self-care and mobility limitations at discharge, which indicate need for occupational therapy and physiotherapy, predicted receipt of community rehabilitation within 90 days, and whether non-clinical factors were independently associated with it.

Most community rehabilitation was delivered through home health: occupational therapy for 52% and physiotherapy for 67%. Far fewer received outpatient occupational therapy (15%) or outpatient physiotherapy (27%). Worse self-care was associated with home health and outpatient occupational therapy use, and worse mobility predicted home health physiotherapy, but mobility did not predict outpatient physiotherapy. Non-clinical factors were independently associated with less home health use, namely younger age, Hispanic ethnicity (compared with White, non-Hispanic) and rurality. Older age, Black or Hispanic ethnicity, being unmarried and Medicaid eligibility were associated with less outpatient rehabilitation. The authors conclude that clinical need was not a dominant influence on use and that non-clinical factors shaped access.

The study is American and payer-specific, and much of the pattern will reflect Medicare and Medicaid rules, so it cannot be transferred to the NHS as a rate. It measures receipt of services within 90 days, not recovery or the patient’s own experience of the wait. What transfers is the question it poses: after a patient leaves a rehabilitation bed, does access follow need or follow geography and circumstance? Rurality is the factor most directly relevant to dispersed populations.

It extends the published pattern that disadvantage lengthens time in the system and lowers recovery from recovery and length of stay to access. The published pattern’s note that no UK evidence has yet been found still stands.