Skilled Nursing Facility Rehabilitation Intensity and Successful Discharge in Persons with Dementia.

This was an observational record study, not a randomized trial, so it cannot prove that more therapy hours caused successful discharge. The lowest therapy-hours group had much higher early death, which the authors describe as suggestive of confounding. The study did not measure patient factors such as willingness to engage in therapy, which could be associated with both therapy hours and discharge. Therapy hours were grouped together, so the contribution of physical therapy, occupational therapy, speech-language therapy, and audiology cannot be separated. The study assumed an hour of each service was interchangeable and equivalent across nursing homes, but it did not collect prospective data on specific therapy methods and goals. The sample was mostly men and mostly White Veterans, so results may not apply to non-Veteran populations. The primary outcome was successful discharge within 90 days, with survival and no rehospitalization, not a separate functional outcome.

The authors declared no conflicts of interest. The article is marked as supported by non-U.S. government research funding.

Do not read this as proof that increasing therapy hours will help a patient with dementia return home. The study only showed an association in records, and the lowest therapy group had much higher early death, so patient factors such as willingness to engage may explain part of the difference.