What is the estimated rehabilitation time per day of sometime hospitalized (in hospital) for a patient, depending on their condition and overall health?

Rehabilitation Time Per Day of Hospitalization

For inpatient stroke rehabilitation, patients should receive 3 hours per day of direct task-specific therapy, 5 days per week, delivered by an interprofessional team, as more intensive therapy consistently produces better functional outcomes. 1

Stroke Rehabilitation Standards

The most recent and highest-quality guidelines establish clear intensity benchmarks:

• Inpatient Rehabilitation Facilities (IRFs): Patients must participate in at least 3 hours of rehabilitation therapy per day for at least 5 days per week (or 15 hours within consecutive 7-day periods) 1
• Canadian Best Practice: Recommends 3 hours per day of direct task-specific therapy, 5 days per week for optimal recovery 1
• This therapy time includes combined physical therapy, occupational therapy, and speech-language pathology services 1

Reality vs. Guidelines

Important caveat: Actual practice often falls short of these standards. A Canadian study found stroke patients received only 37 minutes per day of active therapy from both physiotherapists and occupational therapists, far below the 1-hour minimum recommendation 2. Despite this gap, total occupational therapy time remained a significant predictor of functional improvement 2.

Pulmonary Rehabilitation Standards

For hospitalized patients with respiratory conditions:

• Outpatient programs: Typically 1-4 hours per session, 2-3 days per week 1
• Inpatient programs: Usually planned for 5 days per week during hospitalization 1
• Session length is generally within the attention span and physical capability of patients with chronic respiratory disease 1
• Resistance training during hospitalization for acute exacerbations is well-tolerated and safe 1

Skilled Nursing Facilities (SNFs)

For patients requiring less intensive rehabilitation:

• Less than 3 hours per day, up to 5 days per week to improve functional ability 1
• Rehabilitation nursing must be on-site for a minimum of 8 hours per day 1
• No requirement for direct daily physician supervision 1

Critical Illness and Prolonged Hospitalization

For severely ill patients (e.g., COVID-19, mechanical ventilation):

• Patients averaged 165 minutes per day (2.75 hours) of combined therapy during inpatient rehabilitation 3
• This frequent, long-duration approach was safe and feasible, with 93% discharged to community 3
• For older adults with prolonged hospitalization (≥14 days), median rehabilitation duration was only 61.3 minutes per week, highlighting significant underutilization 4

Key Clinical Considerations

Timing matters: Early rehabilitation initiation (within 24-48 hours of stroke onset if no contraindications) improves outcomes 1. For pulmonary patients, rehabilitation within 3 weeks after acute exacerbation is feasible, safe, and effective 1.

Common pitfall: Do not assume medically stable patients with mild deficits don't need intensive rehabilitation. Even patients scoring zero on the National Institutes of Health Stroke Scale may have discernible motor deficits requiring therapy 1.

Disparities exist: Racial/ethnic minorities, non-English speakers, and patients with do-not-resuscitate status receive significantly less rehabilitation time, independent of clinical severity 4.

Practical Rule of Thumb

For each day of hospitalization requiring rehabilitation:

• IRF setting: 3 hours/day minimum (stroke, severe illness) 1
• SNF setting: <3 hours/day 1
• Pulmonary inpatient: 1-4 hours/session, 5 days/week 1

The evidence consistently shows that more therapy produces better outcomes 1, making intensity a critical factor in rehabilitation planning regardless of the underlying condition.