Scott Webb (Host): Inpatient rehabilitation is designed to maximize a patient's physical function after stroke, trauma, injury, and prolonged hospitalizations.

And I'm joined today by Dr. Sachin Mehta. He's the Medical Director of Franciscan Health Indianapolis Acute Inpatient Rehabilitation, and he's here today to discuss the many benefits of inpatient rehab.

 This is the Franciscan Health Doc Pod. I'm Scott Webb.

Doctor, it's great to speak with you again. Today we're going to talk about inpatient rehab and what that means exactly. So let's just start there. What is inpatient rehabilitation?

Sachin Mehta, DO: So inpatient rehabilitation is a intensive, personalized, customizable rehabilitation program for someone who's suffered a serious injury, trauma, or illness that affects their function, their daily functioning. It affects their ability to do their daily activities such as bathing and dressing, their mobility and walking, or even their cognition and swallowing, for their thinking skills, their memory, attention, concentration, problem solving.

So this intensive rehabilitation program, is a program where they get 15 hours of rehab, a minimum of 15 hours of rehab per week. Usually it's approximately three hours of therapy over a five day period, with some rest and recovery time on the weekend. And this therapy program is completed by at least two of three therapy disciplines between physical therapy, occupational therapy, and speech therapy.

So physical therapists work on mobility and walking and leg strengthening. Occupational therapists work on activities of daily living, bathing and dressing, as well as upper extremity strengthening. Speech therapists work on speech, swallowing, and also our cognition, which is all of our thinking skills, memory, problem solving, etc.

The program is then overseen by a physiatrist, which is a physician who specializes in physical medicine and rehabilitation, and that's what I do. And the goal of the physiatrist is to oversee the rehabilitation and try to address any issues that may impact the patient's ability to participate in this aggressive, intensive rehab program. The other important component of inpatient rehabilitation is that there is 24/7 rehabilitation nurses available.

Rehabilitation nurses specialize in normal hospital nursing, but also specialize in other functions such as bowel and bladder retraining to try to prevent incontinence. And to make sure our patients get optimal control of their bowel and bladder function and they specialize in prevention of skin breakdown and medication management.

And then the, the most important component to me of inpatient rehabilitation is the multidisciplinary team conference, which states that every patient is required to have a team conference where the entire rehab team of therapists, physicians, nurses, and case managers meets on a weekly basis and discusses each patient individually on what's going well, what's not going well, what do we need to do to optimize their ability to gain their independence and get back home?

Host: Yeah, I actually have a family friend who just had a stroke recently and so I'm more familiar with inpatient rehab than I normally would be. But what, generally, what types of patients qualify to receive care from an inpatient rehab program?

Sachin Mehta, DO: The types of patients that qualify to receive care from an inpatient rehab program is really dependent on whether they've had a change in function. There's no specific diagnosis that are exclusions to inpatient rehab. So if anybody's had any type of injury, such as a stroke, or a trauma such as a brain injury or spinal cord injury, or just was hospitalized because of an illness such as COVID or pneumonia or a bladder infection or urinary tract infection, and this illness or injury has impacted their function in terms of their ability to be safe at home; they can potentially qualify to receive inpatient rehabilitation.

Some of the formal criteria are that they have to be quote unquote able and willing to participate in intensive rehabilitation. They have to have a medical need for physiatry oversight. And again, physiatry is a physician who specializes in physical medicine and rehabilitation, and they have to require 24/7 rehab nursing needs.

But we have an admissions team that addresses these criteria, looks at the patient's home situation in terms of who's available to help them at home and what is their house set up like and make sure that they meet the insurance criteria for inpatient rehabilitation. To summarize this, essentially anybody that's had a change in function, that would benefit from intensive rehabilitation to gain their independence and get home.

Host: Yeah. And as you said, willing and able, of course. And when you think about a patient and the options they have, so when they're trying to select an inpatient rehab center, what types of things should they be looking for? What types of questions should they be asking?

Sachin Mehta, DO: The types of questions a patient should be asking in considering when they choose an inpatient rehabilitation setting is varied. A lot of these inpatient rehab facilities are attached to the hospital. So oftentimes the patients would like to maintain that continuity of their own physicians and caregivers providing continued medical oversight while they transition to inpatient rehabilitation.

Some other facilities are freestanding. So what we want to do is we want to make sure we kind of find what's the best option for them, whether it's to stay in the hospital or maybe go to a freestanding rehab hospital closer to their home. There's a lot of public outcome data that's published, so, patients and their families can look to see, look at the quality metrics of an inpatient rehab facility.

And patients and families are welcome to visit the Inpatient Rehab Center to see where they might be most comfortable.

Host: Yeah, I'm sure that that helps. So after a patient has completed inpatient rehab and they begin to look more at outpatient rehabilitation, how often does that take place? oHow often do patients need that? How much rehabilitation do they need once they've completed the inpatient side?

Sachin Mehta, DO: An important thing to remember about inpatient rehabilitation that it's intensive but it's a short duration. Our average length of stay nationally for an inpatient rehab center is approximately 12 to 14 days. And as we know with certain devastating injuries, we need rehabilitation more than just for a couple weeks.

So the goal of inpatient rehabilitation is to get home and stay home and do our basic daily functions. Now, when someone gets home, there are two options for rehabilitation. If someone is homebound and cannot leave their house, there are some therapists and nurses that can come to the house a couple days a week for 45 minutes or an hour, and that's called home health therapy and nursing. For someone who maybe has transportation and would prefer a more aggressive, intensive outpatient program, an outpatient rehab setting would be optimal where they can get two to three days of outpatient therapy for two to three hours per day in a more of a specialized environment with therapists who specialize in certain diagnoses.

There's therapists who specialize in head injury, stroke recovery. But the ultimate goal of outpatient rehabilitation is to kind of reintegrate in the community, be able to hang out with our friends, go to church, return to driving, return to work, return to school, return to our hobbies and other recreational activities.

So the outpatient program is a higher level specialized program to continue to reintegrate into our community. Now that's again, an individualized program just like inpatient rehab and an average outpatient rehab program can last anywhere from six weeks to six to nine months based on their needs.

And then what we usually do is on the off days, we provide them an aggressive home exercise program to continue working on these functional skills at home. So, ideally, if someone has transportation, an outpatient program is an optimal way to continue the progress they have made in an inpatient rehab setting and continue making these functional gains to maintain their independence and then try to do the activities they were doing before they had their injury.

Host: Yeah, I see what you mean. What advice do you have to give patients who find themselves needing inpatient rehab to give them the best opportunity for recovery?

Sachin Mehta, DO: The advice I would give for patients to optimize their recovery in an inpatient rehab setting is the first of all, to realize that we have to be able and willing to do the therapy and work hard. We also only have a short amount of time, so we want to make sure that we take advantage of every day that we get.

So what I would recommend the patients is to talk to their doctors and nurses on the hospital side to make sure that any of their medical issues or other barriers are addressed to the best of their abilities, that they're sleeping well at night, that they're awake and alert during the day, that their pain is being managed. Their other medical issues such as blood pressure issues and hypertension or diabetes are being optimized medically so that they can really purely focus on the rehabilitation at the inpatient rehab setting. So my advice would be to make sure we address any of these issues as early as possible so that in the two weeks that we get on an inpatient rehab setting that we can really focus on trying to get home.

Host: Yeah, I see what you mean, right? Take up those things before the rehab starts, you can focus just on the rehab, and then we've talked about inpatient today and potentially outpatient later, so good stuff today, thank you so much, and you stay well.

Sachin Mehta, DO: Thank you, Scott.

Host: And for more information, visit FranciscanHealth.org and search inpatient rehabilitation.

And if you found this podcast helpful, please share it on your social channels and be sure to check out the full podcast library for additional topics of interest. This is the Franciscan Health Doc Pod. I'm Scott Webb. Stay well, and we'll talk again next time.