High-intensity gait training in subacute stroke resulted in increased discharge home from inpatient rehabilitation: a quality improvement study

Background High-intensity gait training (HIGT) has emerged as a promising intervention to improve walking outcomes post-stroke. This quality improvement project aimed to increase the intensity of gait training for patients post-stroke in inpatient rehabilitation and evaluate HIGT's effects on functional mobility and discharge outcomes. Methods Eighty-four patients post-stroke admitted to inpatient rehabilitation (2019–2021) were divided into HIGT ( n = 32) and standard of care (SoC; n = 52) groups. Baseline characteristics were compared using t -tests or χ 2 tests. Linear mixed-effects models evaluated changes in Inpatient Rehabilitation Facility Patient Assessment Instrument (IRF-PAI) (total and item-level) and secondary outcomes (6-min walk test (6 MWT), 10-Meter Walk Test (10 MWT), berg balance scale (BBS), Functional Gait Assessment, Five Times Sit to Stand Test, and Activities-Specific Balance Confidence Scale). Logistic regression examined predictors of discharge destination. Results Groups were similar at baseline except for length of stay, which was longer for HIGT (16.6 vs. 11.1 days; p < 0.01). IRF-PAI Mobility improved significantly across all patients ( p < 0.001), with a significant time × group interaction ( p = 0.035) favoring HIGT. Item-level differences favored HIGT for “Chair/Bed-to-Chair Transfer” ( p = 0.007), “Sit to Stand” ( p = 0.005), and “Walk 10 Feet” ( p = 0.008). Secondary outcomes improved within groups ( p < 0.05) but did not differ significantly between groups. HIGT participants were more likely to discharge home (adjusted OR = 8.0, 95% CI [2.26–39.1], p = 0.003). Conclusion Patients receiving HIGT demonstrated greater functional mobility gains and were more likely to discharge home than those receiving standard care. HIGT may enhance post-stroke recovery and support independent living. Further research should assess fidelity, long-term outcomes, and broader implementation.