Key result
Acute care physical therapists show low agreement on discharge recommendations unexplained by training or experience.
Why the study?
Evidence suggests better outcomes when physical therapist discharge recommendations are followed, but preliminary work suggests acute care physical therapists may be inconsistent when making these recommendations.
Cross-Sectional
Yes
Acute care physical therapists demonstrate low agreement in post-acute care discharge recommendations, indicating a need for strategies to improve calibration and shared understanding.
Acute care PT discharge recommendations show poor agreement; leaves open whether standardization improves consistency independent of experience or training.
BACKGROUND: Physical 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. METHODS: Acute 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. CONCLUSIONS: Discharge 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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Crick et al. (2026) conducted a cross-sectional in Post-acute care discharge planning. Electronic survey with ten clinical vignettes was evaluated on Consistency of discharge recommendations (Fleiss' Kappa). Discharge recommendations among acute care physical therapists showed low agreement nationally, and variability was not explained by training or experience.
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