Acute Care Therapy vs. Inpatient Therapy: What is the Difference?

If you’re a newcomer to the industry, the rehab therapy space can be a little confusing. There are a variety of settings, care modalities, and industry terms to wrap your head around. Even seasoned rehab therapists can have a hard time keeping it all straight.

Of the various types of rehab therapy, two of the most commonly confused are acute care hospital physical therapy and inpatient physical therapy (AKA inpatient rehab)—not only due to their similarities, but also because they often go by different names.

Let’s talk about what these two therapies have in common and where they differ.

Acute Care Therapy vs. Inpatient Physical Therapy

What Do These Terms Mean?

Let’s start by defining these two terms to add important context for their comparison. After all, we can’t compare without knowing what it is that we’re comparing.

What Is Acute Care Therapy?

Acute care therapy is the type of rehabilitation therapy that often occurs within a general hospital setting. It’s designed to provide early intervention for patients who have been admitted to the hospital, including those who are critically ill.

Other names for acute therapy include:

• Hospital-based therapy
• Acute inpatient therapy
• Acute rehabilitation
• Early phase rehabilitation

What Is Inpatient Physical Therapy?

Inpatient physical therapy is the type of rehabilitation therapy that occurs within a specialized facility, such as a rehabilitation hospital, and is designed for patients who require intensive, ongoing therapy to address significant physical impairments or disabilities.

Like acute care therapy, inpatient physical therapy also goes by a few other names:

• Inpatient rehab or rehabilitation
• Post-acute inpatient rehab

Note: We will use the term inpatient rehab in place of inpatient physical therapy, as the former term covers a wider spectrum of rehabilitation practices that include physical, occupational, and speech-language therapies.

Care Goals

The goals of each type of therapy are primarily driven by a time component. For example, acute care therapy focuses on:

• Stabilization. Prioritizing immediate medical needs and stabilizing a patient’s condition following an acute illness or injury.
• Pain management. Implementing strategies to alleviate pain and discomfort, allowing for optimal healing and participation in therapy.
• Prevention of complications. Taking proactive measures to reduce the risk of secondary complications like pneumonia, blood clots, or muscle atrophy.
• Early mobilization. Encouraging early movement and activity to promote healing, prevent muscle weakness, and prepare for discharge.
• Preparation for discharge. Equipping patients with the necessary skills and knowledge to safely transition home or to a lower level of care. This may involve education on medication management, wound care, or exercise routines.

In contrast, inpatient rehab focuses on:

• Functional improvement. Targeting specific functional limitations, such as difficulty walking, dressing, or performing daily tasks.
• Maximizing independence. Helping patients regain as much independence as possible, reducing reliance on caregivers and improving quality of life.
• Quality of life enhancement. Addressing physical, psychological, and social factors that impact a patient’s overall well-being. This may involve pain management, fatigue reduction, and emotional support.
• Skill acquisition. Teaching patients new skills, such as using assistive devices, performing specific exercises, or adapting to environmental barriers.
• Community reintegration. Preparing patients to reintegrate into their communities, including addressing transportation needs, social activities, and vocational rehabilitation.

While both settings may involve pain management and functional improvement, the emphasis and intensity of these interventions differ. Acute care therapy focuses on immediate needs and stabilization, while inpatient rehab emphasizes long-term functional goals and community reintegration.

Care Setting Differences

In most cases, acute care therapy is typically performed in:

• Hospitals. This is the most common setting for acute care therapy. Patients who have undergone surgery, experienced a sudden illness, or have a serious injury may receive therapy services directly in the hospital.
• Rehabilitation hospitals. While these facilities are primarily associated with inpatient rehabilitation, they may also offer acute care therapy services for patients who require immediate intervention before transitioning to a more intensive inpatient program.

Though the specific setting for inpatient rehab will depend on the patient’s individual needs and the level of care required, patients are typically treated in:

• Rehabilitation hospitals. These specialized facilities are designed to provide intensive therapy services to patients with significant disabilities or impairments. They offer a wide range of therapies, including physical therapy, occupational therapy, and speech-language pathology.  
• Skilled nursing facilities (SNFs). SNFs provide 24-hour nursing care and rehabilitation services to patients who need assistance with daily living activities. They often offer physical therapy as part of a comprehensive rehabilitation program.  
• Long-term acute care hospitals (LTACHs). These hospitals are designed for patients who require extended acute care, such as those recovering from complex medical conditions or surgeries. They often offer physical therapy services to help patients regain function and strength.  

Who Is Most Likely to Receive Each Type of Therapy?

Acute care therapy usually serves populations such as:

• Post-surgical patients. Individuals who have undergone surgeries like hip or knee replacements, spinal surgeries, or orthopedic procedures.
• Patients with acute medical conditions. Those experiencing sudden illnesses like pneumonia, heart attack, or stroke.
• Traumatic injury patients. Individuals who have sustained injuries from accidents, falls, or other traumatic events.  

Inpatient rehab, on the other hand, serves populations that include:

• Patients with complex medical conditions. Individuals with multiple health issues, such as chronic obstructive pulmonary disease (COPD), heart failure, or diabetes.  
• Patients recovering from significant injuries or illnesses. Those who require intensive therapy to regain function and independence, such as stroke survivors, spinal cord injury patients, or individuals with traumatic brain injuries.
• Elderly patients. Older adults who need rehabilitation to improve mobility, strength, and balance.

While there are distinct patient populations for each therapy, you may see overlap with patients transitioning from acute care to inpatient rehab, patients with complex medical conditions, patients recovering from surgery, and some older adults who need both types of therapy.

Common Interventions in Each Therapy Type

The type of patients may vary for acute care therapy, but they will be treated with interventions such as:

• Pain management techniques. Using modalities like heat, cold, or electrical stimulation to reduce pain and inflammation.
• Range-of-motion exercises. Performing passive or active range of motion exercises to maintain joint mobility and prevent contractures.
• Basic functional training. Assisting patients with activities of daily living like getting in and out of bed, transferring to a chair, and walking.
• Education and training. Providing patient education on injury prevention, pain management strategies, and home exercise programs.

Interventions for inpatient rehab include:

• Intensive therapeutic exercise. Engaging in a variety of exercises, including strength training, cardiovascular conditioning, and balance training.
• Functional training. Practicing complex functional tasks, such as stair climbing, bed mobility, and transfers.
• Gait training. Improving walking patterns and gait mechanics to enhance mobility and safety.
• Manual therapy techniques. Utilizing techniques like massage, mobilization, or manipulation to reduce pain and improve joint mobility.
• Specialized modalities. Employing modalities like ultrasound, electrical stimulation, or aquatic therapy to promote healing and reduce pain.
• Community reintegration training. Preparing patients to return to their homes and communities, including addressing transportation, social activities, and vocational rehabilitation.

Both acute care and inpatient rehab share commonalities in the type of interventions (e.g., pain management, functional training); however, the intensity and duration of these interventions often differ.

Interdisciplinary Collaboration

Interdisciplinary collaboration (IC) involves healthcare professionals working together to provide comprehensive care to patients. This collaboration is particularly important in rehabilitation settings like acute care therapy and inpatient rehab where patients often have complex needs that require a multi-faceted approach.

IC in Acute Care Therapy

In acute care settings, IC is often more informal and focused on immediate needs. The team typically includes physicians, nurses, physical therapists, occupational therapists, speech-language pathologists, and case managers.

Collaboration in acute care settings is essential for:

• Rapid stabilization. Quickly addressing the patient’s medical and functional needs to prevent complications.
• Efficient discharge planning. Coordinating care to ensure a smooth transition to home or a lower level of care.
• Early mobilization. Encouraging early movement and activity to promote healing and prevent secondary complications.

Team members in acute care settings may meet daily to discuss patient progress, adjust treatment plans, and address any concerns. This frequent communication helps to ensure timely and effective care.

IC in Inpatient Rehab

Inpatient rehab settings require a more structured and intensive approach to IC. The team typically includes physicians, nurses, physical therapists, occupational therapists, speech-language pathologists, psychologists, social workers, and case managers.

Collaboration in inpatient rehab settings is essential for:  

• Developing comprehensive treatment plans. Creating individualized plans that address the patient’s physical, cognitive, and emotional needs.
• Monitoring progress and adjusting goals. Regularly evaluating the patient’s progress and modifying the treatment plan as needed.
• Facilitating community reintegration. Helping patients transition back to their homes and communities by addressing transportation, housing, and social support needs.

Inpatient settings often have formal interdisciplinary team meetings, such as care conferences or family meetings, to discuss patient progress, set goals, and coordinate discharge planning. These meetings provide an opportunity for team members to share information, identify potential challenges, and develop strategies to address them.

Commonalities

Despite the differences in setting and intensity, IC in both acute care and inpatient rehab therapy settings share several common goals.

• Improved patient outcomes: By working together, healthcare professionals can provide more comprehensive and effective care, leading to better patient outcomes.
• Enhanced communication: Effective communication among team members helps to avoid errors, reduce confusion, and ensure that patient needs are met.
• Optimized resource utilization: By coordinating care and sharing expertise, healthcare professionals can use resources efficiently and reduce costs.
• Patient-centered care: IC helps to ensure that patient preferences and values are considered in all aspects of care.

What Are the Biggest Provider Challenges in Each Type of Therapy?

As a rehab therapist, you’ll face a number of challenges unique to the therapy you choose to practice, no matter which setting that is. For example, with acute care therapy, you’ll deal with:

• Time constraints. Acute care settings often have high patient volumes and shorter length of stays, which can limit the amount of therapy time available for each patient.
• Rapidly changing patient conditions. Patients in acute care can experience sudden changes in their condition, requiring therapists to adapt their treatment plans quickly.  
• Complex medical conditions. Acute care patients often have multiple medical comorbidities, which can complicate their rehabilitation and require careful coordination with other healthcare providers.  
• Interdisciplinary collaboration. While essential, interdisciplinary collaboration in acute care can be challenging due to time constraints and competing priorities.

While with inpatient rehab, you’ll face:

• Intensive workload. Inpatient rehab therapists often have demanding schedules and high caseloads, requiring efficient time management and prioritization.  
• Complex patient populations. Inpatient rehab patients may have severe disabilities or complex medical conditions, requiring specialized knowledge and skills.  
• Long-term goals. Inpatient rehab focuses on long-term goals, such as returning to work or independent living, which can be challenging to achieve for some patients. It also means more specific documentation to track patient progress over a longer period of time.
• Patient motivation. Maintaining patient motivation and engagement can be difficult, especially for patients with chronic conditions or limited functional abilities.

On either therapy path, you’ll have to deal with the common challenges of staffing shortages, documentation and administrative tasks, and reimbursement difficulties.

Ethical Considerations

Ethics are also an important consideration for acute care therapy and inpatient rehab. In acute care settings, you’ll be forced to grapple with:

• Resource allocation. In acute care settings, there may be limited resources, such as beds, staff, and equipment. Healthcare providers must make difficult decisions about how to allocate these resources fairly and ethically.  
• End-of-life care. Acute care settings often present complex end-of-life decisions, such as whether to initiate or withdraw life-sustaining treatment. While this is unlikely to be the job of physical therapists, it’s helpful to remember that this setting involves a higher risk for your patients than practicing in a private practice or focused on longer-term rehab. 
• Informed consent in acute situations. Obtaining informed consent can be challenging in acute care settings, especially when patients are critically ill or incapacitated.  

Inpatient rehab presents its own set of ethical considerations, such as:

• Quality of life. Inpatient rehab often involves balancing the potential benefits of aggressive therapy with the potential burdens and risks of treatment.
• Patient autonomy and decision-making. Inpatient rehab patients may have cognitive impairments or other limitations that affect their decision-making capacity. This can raise ethical questions about informed consent and surrogate decision-making.
• Resource utilization. Inpatient rehab can be resource-intensive, and there may be pressure to discharge patients early to free up beds and reduce costs. This can lead to ethical dilemmas about the appropriate level of care and the potential for adverse outcomes.

As is commonly the case with any therapy, you’ll also be faced with ethical considerations such as beneficence, non-maleficence, and autonomy regarding your patients.

Software Usage in Therapy Settings

Because of the unique nature of the acute therapy environment and its individual operational demands separate from those in inpatient rehab, hospitals, and care networks often use specialized software platforms, such as Net Health ReDoc, within acute therapy departments and acute care facilities.

These electronic health record (EHR) systems help streamline tasks like patient documentation, treatment plans, staff scheduling, patient visits, and billing.

In contrast, for inpatient rehab, many hospitals use institution-wide EHR systems that are more general and are used across several departments. However, there are EHR systems, like ReDoc, that perform as therapy-specific EHRs and interface with the general hospital EHR to promote interoperability.

Which Therapeutic Path Will You Choose?

Acute care therapy and inpatient rehab settings, while distinct, share many commonalities and interdependencies. Both settings require skilled rehabilitation therapists who can adapt to diverse patient populations, complex medical conditions, and evolving healthcare landscapes.

By staying informed about the latest evidence-based practices, advocating for your patients, and fostering strong interdisciplinary relationships, you can continue to make a significant impact on the lives of those you serve—whichever therapeutic path you choose.