ArticlePhysiotherapy theory and practice2026
Consistency of post-acute care discharge recommendations among acute care physical therapists: a national vignette survey study.
Article in Physiotherapy theory and practice, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundPhysical therapists (PTs) contribute to discharge planning by recommending post-acute setting and rehabilitation needs. Evidence suggests better outcomes when PTs recommendations are followed, yet preliminary work suggests acute care PTs may be inconsistent when making discharge recommendations. PURPOSE: To quantify consistency of acute care PT discharge recommendations using standardized vignettes and evaluate whether degree level, years of experience, and experience in settings besides acute care influence therapist consistency.
methodsAcute care PTs completed an electronic survey with ten clinical vignettes and selected an optimal discharge recommendation. Agreement was assessed with Fleiss' Kappa (95% CI); subgroup Kappa values were compared with two-tailed Z-tests.
resultsOne hundred nine acute care PTs from across the United States were included. Overall agreement across ten vignettes was poor (Kappa = 0.20; 95% CI 0.13, 0.31); mean pairwise agreement was 36.6% (range 19.0%-73.0% by vignette). Agreement varied by recommendation: inpatient rehabilitation (Kappa = 0.34) and outpatient PT (0.32) showed fair agreement; home health (0.17), skilled nursing (0.14), subacute rehabilitation (0.11), no PT needs (0.01), and long-term acute care (<0.01) showed poor agreement. Combining skilled nursing and subacute rehabilitation improved overall agreement to fair (0.28; 95% CI 0.19, 0.41) and increased agreement for the merged category (0.34). Consistency did not statistically differ by degree, total experience, acute care experience, or other-setting experience (all
conclusionsDischarge recommendations among acute care PTs showed low agreement nationally, particularly across adjacent post-acute options, and variability was not explained by training or experience. Results support strategies to improve calibration and shared understanding of post-acute settings to better match patients to services and reduce potentially avoidable costs.
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