Rehabilitation Outcomes in a Community Hospital Post-Stroke Unit: A Case Study

Thesis Abstract

Stroke rehabilitation in community hospital post-stroke units faces variable patient outcomes influenced by organizational processes, resource constraints, and continuity of care across the transition to home and community services. This study addresses the gap in empirical evidence on how unit-level rehabilitation practices within a community hospital setting affect functional recovery, discharge disposition, and patient-reported quality of life, considering the influence of multidisciplinary teamwork and patient engagement. The aim is to evaluate rehabilitation outcomes within a community hospital post-stroke unit and to identify organizational determinants that predict functional independence, mobility, and successful community reintegration. Specific objectives are to (1) quantify functional outcomes at discharge and at 3- and 6-month follow-ups using the Barthel Index and the Modified Rankin Scale; (2) assess mobility and balance changes via the Timed Up and Go test and the Berg Balance Scale; (3) evaluate patient-reported quality of life with the Stroke-Specific Quality of Life Scale (SS-QOL); (4) examine the impact of multidisciplinary team processes on outcomes through measures of team functioning and therapy intensity; (5) determine predictors of discharge destination and 6-month community reintegration; and (6) compare outcomes across demographic and clinical subgroups, such as age, stroke subtype, and baseline disability. The study adopts a prospective, longitudinal, mixed-methods design conducted in a single community hospital designated post-stroke unit. The population comprises adults (?18 years) admitted with acute ischemic or hemorrhagic stroke within 48 hours of onset, medically stable for rehabilitation, and planned for inpatient post-stroke rehabilitation. A sample of 240 eligible patients will be recruited over 24 months, with a consecutive sampling approach, and followed up at 3 and 6 months post-discharge. Data collection will combine quantitative instruments—Barthel Index (BI), Modified Rankin Scale (mRS), Timed Up and Go (TUG), Berg Balance Scale (BBS), SS-QOL, length of stay, dose of each therapy modality, and discharge disposition—with qualitative insights from semi-structured interviews with 25 patients and 15 staff members (physiotherapists, occupational therapists, speech-language pathologists, nurses) to contextualize outcomes within organizational processes. Validity and reliability will be ensured through standardized protocols, training of assessors, interrater reliability checks (? and intraclass correlation coefficients), and triangulation between quantitative results and qualitative themes. Statistical analyses will include descriptive statistics to characterize the cohort, repeated-measures ANOVA or linear mixed-effects models to examine changes over time in BI, mRS, TUG, BBS, and SS-QOL, and multivariable regression analyses to identify independent predictors of functional outcomes, controlling for age, sex, stroke type, baseline disability, comorbidities, and therapy intensity. Mediation analyses will explore whether multidisciplinary team functioning mediates the relationship between therapy dose and outcomes. Qualitative data will be analyzed using thematic analysis, with coding conducted independently by two researchers and discrepancies resolved through consensus, followed by integration with quantitative findings in a convergent mixed-methods framework. Theoretical underpinnings will include the International Classification of Functioning, Disability and Health (ICF) framework to map body functions, activities, participation, and contextual factors, and the Systems Theory of organizational behavior to interpret unit-level processes. Expected findings anticipate significant improvements in independence (BI) and mobility (TUG, BBS) from admission to 3 months with sustained gains at 6 months, and enhanced quality of life (SS-QOL) correlating with higher therapy intensity and cohesive multidisciplinary collaboration. Discharge to home with support and positive community reintegration is expected to associate with shorter hospital stays, higher initial functional gains, and favorable organizational factors such as timely access to therapy, standardized discharge planning, and robust follow-up linkage to community services. The study will contribute knowledge by elucidating the extent to which post-stroke rehabilitation outcomes in community hospital units reflect organizational capacity, multidisciplinary teamwork, and continuity of care, offering evidence to inform targeted interventions, staffing models, and care pathways to optimize recovery. Recommendations include implementing standardized, protocol-driven rehabilitation pathways, enhanced transitional care coordination with primary care and community rehabilitation services, routine measurement of patient-reported outcomes, and ongoing audits of team performance to sustain clinically meaningful improvements in post-stroke recovery within community hospital settings.