Many stroke patients miss intensive rehabilitation after hospitalization

Fewer than one in four people with stroke and fewer than one in seven people with traumatic brain injury receive inpatient rehabilitation care after being hospitalized, according to a study published on June 10, 2026, in Neurology^® Open Access, an official journal of the American Academy of Neurology. Researchers found disparities in access across sex, race, insurance coverage and income level.

Receiving intensive rehabilitation after stroke, traumatic brain injury and spinal cord injury can improve a person's recovery, yet access to inpatient rehabilitation care remains inconsistent and may not be equitable."

Farhaan S. Vahidy, MBBS, PhD, study author of TIRR Memorial Hermann in Houston, Texas, and member of the American Academy of Neurology

"Inpatient rehabilitation facilities provide more intensive rehabilitation care, usually more than three hours per day, than skilled nursing facilities," said Vahidy. "Our study found fewer people receive this type of rehabilitation than are likely eligible, with concerning disparities affecting historically marginalized communities, people with Medicaid and those from lower-income areas."

For the study, researchers reviewed four years of health records in five states to identify 444,908 adults hospitalized for stroke, traumatic brain injury and traumatic spinal cord injury. They had an average age of 69. Of participants, 75% had stroke, 24% had TBI and 1% had spinal cord injury. After hospitalization, 22% were discharged to inpatient rehabilitation facilities, 26% to skilled nursing facilities and 54% were sent home.

Researchers found just 22% of those with stroke and 14% of those with traumatic brain injury were sent to an inpatient rehabilitation facility, while the number was 44% of those with spinal cord injury. That is fewer than one in four people with stroke and one in seven people with brain injury discharged to an inpatient rehabilitation facility.

Researchers also looked at the differences between various groups of people.

After adjusting for factors such as insurance, a person's home residence and health factors like high blood pressure and diabetes, researchers found older people with an average age of 75 had 4% higher odds than younger people with an average age of 63 of being discharged to an inpatient rehabilitation facility versus home, female participants had 19% higher odds than male participants, and Black people had 29% higher odds than white people while Hispanic people had 22% lower odds.

The researchers note several limitations when interpreting these findings. The analysis looked back at administrative data and cannot determine causal relationships or account for unmeasured factors that influence hospital discharge, especially social and individual factors not captured in medical records.

Researchers also found that having private insurance or Medicaid versus Medicare and living in areas with the highest average income compared to areas with the lowest average income were associated with 12% lower odds of being discharged to an institutional rehabilitation facility.

When looking only at people discharged to rehabilitation or skilled nursing care, and not those sent home, Black people had 10% lower odds of being discharged to a rehabilitation facility than a skilled nursing facility.

"Ensuring equitable access to intensive inpatient rehabilitation can help improve long-term outcomes for people with these conditions," said Vahidy. "Future studies should further examine differences in care and develop interventions to reduce disparities."

Another limitation of the study was that the data reviewed did not include information on the severity of strokes, traumatic brain injuries and spinal cord injuries.