How has rehabilitation length of stay changed over the years?

Author: Dominik Zbogar | Reviewer: Giorgio Scivoletto | Published: 30 April 2025 | Updated: ~

In the USA the median rehabilitation LOS has decreased from 91 days in 1972-1979 to 41 days in 2020-2023.

This decrease over the years is a trend also seen in other high-income countries (HIC). This decrease in LOS for inpatient SCI rehabilitation may be due to a combination of several factors reflecting both the evolution of care practices and the economic realities of healthcare delivery:

Early surgical intervention, better acute care, and improved stabilization techniques post-injury may allow for quicker transitions from acute care to rehabilitation or community settings. This is supported by studies showing that early surgery may lead to shorter LOS in acute care, which could impact how soon patients are admitted to rehabilitation.

Economic incentives in healthcare systems, particularly in HICs, have pushed for shorter hospital stays to manage costs. Insurance policies and healthcare reforms often aim to reduce LOS to lower expenditure, which has influenced rehabilitation practices.

Intensity of rehabilitation and not just LOS can influence outcomes. In the US for example, some rehab facilities have a three-hour rule where at least three hours of intensive rehab therapy per day, at least five days a week. This has led to a focus on maximizing therapy within a shorter period, thereby reducing LOS while still aiming for similar or better outcomes. Rehabilitation methods have evolved, emphasizing more intensive, shorter-duration therapies that aim to achieve functional gains more quickly. This includes the use of early, intensive physical therapy, occupational therapy, and other modalities that can lead to earlier discharges.

The availability of advanced assistive devices, home adaptations, and technology for home use allows individuals with SCI to manage more aspects of their care at home, reducing the need for extended inpatient stays.

There is a growing trend towards discharging patients to community settings earlier for continued rehabilitation, supported by home health services, outpatient programs, or community-based rehabilitation centers. This shift is partly due to evidence showing that community integration and social participation can be maintained or even enhanced with earlier discharge.

Changes in the demographics of those injured, and the level and severity of SCI may also play a role. An increase in SCI among older people may increase rehab periods. Conversely, a trend towards more effective complication prevention could lead to shorter rehabilitation periods. Also, a trend towards incomplete SCI could lead to shorter rehabilitation periods. However, this trend towards incomplete SCI is not always reflected in a reduction of LOS as a sizeable subset of those with incomplete tetraplegia suffer from central cord syndrome which has very poor independence recovery.

The next section provides more information on these demographic factors.