Evidence map›Paper›PMID 41038421›Full record

ArticleArchives of physical medicine and rehabilitation2026

Patient Functional Outcomes in Skilled Nursing Facilities: The Mediating Role of Declining Therapy.

Rachel A Prusynski, Andrew Humbert, Harsha Amaravadi, Addie Middleton, Natalie E Leland, Debra Saliba, Cait Brown, Janet Freburger, Tracy M Mroz

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Archives of physical medicine and rehabilitation, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed.

  1. Article
  2. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

9 authors.

Rachel A PrusynskiDepartment of Rehabilitation Medicine, University of Washington, Seattle, WA; Department of Health Systems and Population Health, University of Washington, Seattle, WA. Electronic address: Rachelp1@uw.edu.
Andrew HumbertDepartment of Rehabilitation Medicine, University of Washington, Seattle, WA.
Harsha AmaravadiDepartment of Health Systems and Population Health, University of Washington, Seattle, WA.
Addie MiddletonDepartment of Physical Medicine and Rehabilitation, University of Colorado School of Medicine, University of Colorado, Aurora, CO.
Natalie E LelandDepartment of Occupational Therapy, University of Pittsburgh, Pittsburgh, PA.
Debra SalibaBorun Center, Division of Geriatrics, University of California Los Angeles, Los Angeles, CA; Geriatric Research Education and Clinical Center, Greater Los Angeles Veterans Affairs Medical Center, Los Angeles, CA; RAND Health, Santa Monica, CA.
Cait BrownDepartment of Rehabilitation Medicine, University of Washington, Seattle, WA.
Janet FreburgerDepartment of Physical Therapy, University of Pittsburgh, Pittsburgh, PA.
Tracy M MrozDepartment of Rehabilitation Medicine, University of Washington, Seattle, WA; Department of Health Systems and Population Health, University of Washington, Seattle, WA.

Funding

Scientific/Technical CoreP2CHD042828 · NICHD · UNIVERSITY OF WASHINGTON · PI SARA R. CURRAN · 2017 to 2026
$6.3M
The impact of post acute care payment changes on access and outcomesR01AG065371 · NIA · UNIVERSITY OF PITTSBURGH AT PITTSBURGH · PI LELAND, NATALIE ELIZABETH, MROZ, TRACY MITCHELL · 2021 to 2024
$2.7M
NIA NIH HHS R01 AG065371NICHD NIH HHS P2C HD042828
6 · The paper itself

Abstract

objectiveTo estimate changes in functional outcomes in Medicare fee-for-service skilled nursing facility (SNF) patients after declines in therapy minutes that occurred after Patient-Driven Payment Model (PDPM) implementation and during the COVID-19 pandemic. We also tested the hypothesis that declines in therapy minutes mediated changes in patient functional outcomes.

designRetrospective cohort study using mediation analysis. Exposures were PDPM implementation (October 2019) and COVID-19 pandemic onset (March 2020). The mediator was average minutes of therapy per day (MTD) including all physical, occupational, and speech therapy minutes during the SNF stay.

settingAll US SNFs.

participantsPatients (N=3,534,928) at post-acute SNF stays from January 2018 through September 2021.

interventionsNot applicable.

main outcome measuresFunctional outcomes based on changes in activities of daily living (ADL) scores between SNF admission and discharge, measured by a validated 28-point scale: (1) ADL decline and (2) high ADL improvement (≥4 points improvement). Mediation analysis quantified effects of declining MTD on functional outcomes, adjusting for patient, facility, and community-level confounders.

resultsAverage MTD declined from 122.2 pre-PDPM to 96.5 post-PDPM and further to 87.7 during COVID-19. After PDPM implementation, the adjusted probability of ADL decline increased by 1.7 percentage points (pp) (95% CI: 1.6-1.7); during COVID-19, ADL decline increased by 3.7 pp (95% CI: 3.6-3.7). Declining MTD mediated 47.9% of the increase in ADL decline post-PDPM and 26.5% during COVID-19. The adjusted probability of high ADL improvement increased by 1.3 pp (95% CI: 1.1-1.3) post-PDPM and 1.0 pp (95% CI: 0.8-1.0) during COVID-19. Declining MTD negatively mediated this increase in high ADL improvement by -2.9 pp post-PDPM (95% CI: -2.9 to -2.9) and by -3.5 pp during COVID-19 (95% CI: -3.6 to -3.5).

conclusionsDeclines in SNF therapy after PDPM implementation and during COVID-19 mediated substantial worsening in patient functional outcomes. Ensuring adequate therapy provision may improve functional recovery in SNF patients.

Indexed as

Activities of Daily LivingCOVID-19Physical Therapy ModalitiesSkilled Nursing FacilitiesAgedAged, 80 and overFee-for-Service PlansFemaleHumansMaleMedicareRetrospective StudiesSARS-CoV-2United StatesFunctional statusHealthcare reformOccupational therapyPhysical therapyRehabilitationSkilled nursing facilities

Identifiers

PMID41038421
PMCPMC12517036

What OpenQuestion holds

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Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.