Should rehabilitation be inpatient or outpatient?

What is the difference between inpatient and outpatient rehabilitation?

Inpatient rehabilitation takes place while staying in a hospital or rehabilitation unit, with nursing care and daily therapy from a multidisciplinary team. Outpatient rehabilitation involves travelling to a clinic or centre for therapy sessions while living at home. Home-based rehabilitation brings therapy into the person's home.

Each setting has advantages, and the choice depends on individual needs rather than one setting being right for everyone.

Who usually needs inpatient rehabilitation?

Inpatient rehabilitation suits people who need medical and nursing care alongside intensive therapy, who cannot yet manage safely at home, or who need input from several disciplines every day. Examples include people after moderate to severe stroke, traumatic brain injury, spinal cord injury or major trauma.

A Cochrane review of 29 trials with 5,902 people with stroke found that organised inpatient stroke unit care, provided by coordinated multidisciplinary teams, was associated with lower rates of poor outcome (odds ratio 0.77), death (odds ratio 0.76) and death or dependency (odds ratio 0.75) at a median of one year, compared with alternative services such as general wards 1.

Can rehabilitation continue at home instead?

For suitable people, early supported discharge allows a return home sooner with rehabilitation continuing in the community. A Cochrane review of 17 trials with 2,422 people after stroke found that early supported discharge reduced hospital stay by about six days and reduced the odds of death or dependency (odds ratio 0.80), equivalent to five fewer poor outcomes per 100 patients 2.

Participants in these trials tended to be older stroke survivors with moderate disability, and the benefits were seen particularly when care was delivered by a coordinated multidisciplinary team 2.

How much therapy is needed?

UK guidance on stroke rehabilitation recommends offering people with stroke at least three hours of rehabilitation a day, at least five days a week, across the different therapies they need, if they are able to take part and it is helpful to them 3.

Intensity is adjusted to the person's tolerance and goals. Inpatient settings may make it easier to deliver high-intensity therapy, while home-based therapy allows practice in real-life surroundings.

When is outpatient rehabilitation appropriate?

Outpatient rehabilitation suits people who are medically stable, can travel and live safely at home, and need specific therapy such as physiotherapy, occupational therapy or speech and language therapy a few times a week.

It often follows inpatient or home-based rehabilitation, supporting return to work, driving, community activities and long-term goals.

How is the decision made?

The rehabilitation team considers medical stability, level of disability, cognitive and communication needs, support at home, the home environment, travel practicalities and the person's goals and preferences.

Decisions are reviewed as progress is made. Moving from one setting to another is a normal part of recovery.

What questions help when comparing rehabilitation options?

Useful questions include how much therapy is provided each day and by which professionals, whether care is coordinated by a multidisciplinary team, how goals are set and reviewed, and how family members are involved and trained.

It also helps to ask how discharge is planned, what support continues at home, how equipment and home adaptations are arranged, and who to contact if problems arise after discharge.

Which changes need urgent medical attention during rehabilitation?

In any setting, seek urgent help for new weakness, speech problems, confusion, severe headache, chest pain, breathlessness or seizures.

Tell the team if progress stalls, mood drops or managing at home becomes unsafe, as the setting or plan may need to change.

Frequently asked questions