A Retrospective Analysis of Stroke Rehabilitation Outcomes in the Intermediate Care (IMC) Service Plan Comparing Home-based and Outpatient-Based Services Using Propensity Score Matching

Phuangphet Siriloetthananon; Nataporn  Nakkaew

Authors

Phuangphet Siriloetthananon Department of Rehabilitation Medicine, Songkhla Hospital, Songkhla
Nataporn Nakkaew Physical Therapy Division, Department of Rehabilitation Medicine, Songkhla hospital, Songkhla https://orcid.org/0009-0001-7175-5107

Keywords:

home-based, outpatient-based, functional outcome, intermediate care (IMC), propensity score

Abstract

Objectives: To compare rehabilitation outcomes up to 24 weeks post-stroke, therapy exposure, and complication rates between home-based and outpatient-based IMC stroke rehabilitation programs, before and after propensity score matching in a hospital.

Study design: Retrospective observational cohort design with Propensity Score Matching

Setting: Department of Rehabilitation Medicine, Songkhla Hospital, a tertiary care hospital in southern Thailand

Participants: Intermediate care stroke patients who received rehabilitation services through either the home-based or outpatient-based model between October 2022 and September 2025.

Methods: This retrospective study analyzed stroke patients enrolled in the IMC program. Baseline characteristics, Barthel Index (BI) scores, dependency levels, complications, and therapy session counts were collected at baseline, 2 weeks, 12 weeks, and 24 weeks. Propensity score matching was conducted using initial BI, National Institutes of Health Stroke Scale (NIHSS), age, sex, and other key covariates to ensure baseline clinical balance.

Results: Before matching, the home-based group was older and predominantly female, while the outpatient-based group tended to present with more-severe strokes and lower initial BI scores. The outpatient-based group also received substantially more therapy (median PT: 10 vs. 3; OT: 8 vs. 1; both p < 0.001). After matching, therapy exposure remained higher in the outpatient-based group (PT: 1.6 [SD = 1.9] vs. 8.5 [SD = 6.6], SMD = –1.63; OT: 8.5 [SD = 6.2] vs. 9.2 [SD = 6.2], SMD = –1.43). Short- and intermediate-term BI gains were similar between the groups, with identical median gains during several intervals. Long-term BI gain (baseline–24 weeks) was greater in the outpatient-based group. The home-based group met non-inferiority criteria for BI gain at 24 weeks (p = 0.035), but not at 12 weeks. Trends toward higher pneumonia and pressure ulcer rates were observed in the home-based group, whereas recurrent stroke tended to be more common in the outpatient-based group, though neither reached statistical significance. At 6 months, 62.7% of the home-based and 63.7% of the outpatient-based group had achieved a level of mild or no disability.

Conclusions: Home-based and outpatient-based IMC rehabilitation yielded broadly comparable outcomes despite a substantially lower therapy dosage in the home-based group. Increasing therapy intensity and integrating advanced rehabilitation technologies could potentially further improve functional recovery within the IMC framework. The home-based group demonstrated statistically non-significant trends toward higher rates of preventable complications such as pneumonia and pressure ulcers.

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