Home Health Promotes Functional Improvement Even After Prolonged Inpatient Rehabilitation

December 2025

Following discharge from inpatient rehab, if community-based rehab is not instituted, the common course for geriatric patients is one of plateau or decline.^1-5 In some instances, home health is used to support early discharge, and in-home physical therapy is considered part of the continuation of care. In other cases, rehabilitation is prolonged. From the inpatient perspective, patients have reached their maximum rehab potential or at least the maximum benefit they can achieve with supervised therapeutic exercise. In those cases, the important question is, “Does home-based rehabilitation differ enough that rehab goals can be progressed even after full inpatient rehab?” A recent retrospective analysis concludes, “Yes.”

While inpatient rehabilitation focuses on structured exercise and task simulation in a controlled setting, home health introduces a new dimension: therapy practiced in the real-world environment where the patient must function. Within the home, therapists can identify obstacles that limit independence and modify the environment to overcome them—installing handrails, adjusting furniture heights, or introducing adaptive devices. Activities that were assisted or deemed unsafe in the hospital can often be completed independently at home after targeted training and environmental adjustment. Equally important, therapists work directly with caregivers to prevent “over-care” that undermines patient autonomy, instead coaching families on how to foster safe independence in daily activities such as bathing, dressing, and walking. In this way, home health continues and individualizes the rehabilitation process, extending progress beyond what is achievable in a facility setting.

To test this hypothesis, Sato et al. recently published a retrospective study in which 150 patients received home health after approximately three months of inpatient rehabilitation.⁶ The mean patient age was 81. At the six-month follow-up, participants demonstrated measurable and statistically significant improvement across all major indicators. Grip strength increased from 18.4 to 19.3 kg, performance on the five-times-sit-to-stand test improved from 19.2 to 15.1 seconds, and scores on both the Functional Independence Measure and Frenchay Activities Index rose markedly. Importantly, caregiver burden decreased by nearly 40 percent. Collectively, these results show that home health can advance motor recovery, restore daily living skills, and relieve family strain—even after patients have completed the full course of intensive inpatient rehabilitation.

References

1. Zhao L, Zhao X, Dong B, Li X. Effectiveness of home-based exercise for functional rehabilitation in older adults after hip fracture surgery: A systematic review and meta-analysis of randomized con-trolled trials. PloS One. 2024 Dec 19;19(12):e0315707.
2. Buvarp D, Rafsten L, Abzhandadze T, Sunnerhagen KS. A cohort study on longitudinal changes in postural balance during the first year after stroke. BMC Neurology. 2022 Aug 30;22(1):324.
3. Buvarp D, Rafsten L, Sunnerhagen KS. Predicting longitudinal progression in functional mobility after stroke: a prospective cohort study. Stroke. 2020 Jul;51(7):2179-87.
4. Orwig DL, Hochberg M, Yu-Yahiro J, Resnick B, Hawkes WG, Shardell M, Hebel JR, Colvin P, Mil-ler RR, Golden J, Zimmerman S. Delivery and outcomes of a yearlong home exercise program af-ter hip fracture: a randomized controlled trial. Archives of Internal Medicine. 2011 Feb 28;171(4):323-31.
5. Yoshino J, Sasaki Y, Usuda S. Changes in activities of daily living after discharge from a conva-lescence rehabilitation ward. Rigakuryoho Kagaku. 2008; 23: 495–499.
6. Sato K, Otaka E, Ozaki K, Shiramoto K, Narukawa R, Kamiya T, Kamiya M, Shimotori D, Kamizato C, Itoh N, Kagaya H. Investigating the effects of home-based rehabilitation after intensive inpatient rehabilitation on motor function, activities of daily living, and caregiver burden. PLoS One. 2024 Dec 27;19(12):e0316163.