Consensus Recommendations for Maintaining Neurorehabilitation Quality During Healthcare Crises: A Stakeholder-Informed Mixed Methods Study.

The COVID-19 pandemic significantly disrupted neurorehabilitation practices in Inpatient Rehabilitation Facilities (IRFs), providing an opportunity to examine crisis response strategies. This mixed-methods study examined the pandemic's impact on quality of care through 3 complementary phases: (1) multivariable medical record analysis across 6 neurorehabilitation facilities in a pre-pandemic reference group (n = 134), a non-COVID group (n = 138), a COVID-positive group infected prior to admission ((COV+prior, n = 87) and a group infected during rehabilitation (COV+rehab, n = 36); (2) qualitative analysis of stakeholder consultations with patients (n = 26), staff members (n=55), and managers (n = 7); and (3) integration of quantitative and qualitative results to develop stakeholder and consensus-based recommendations (n = 12 participants). While non-COVID patients (n = 138) maintained pre-pandemic outcome levels, COVID-positive patients showed reduced functional independence at discharge, with distinct trajectories based on infection timing, even after controlling for status at admission. Patients infected during rehabilitation (n = 36) experienced longer stays and higher readmission rates compared to those infected pre-admission (n = 87). Qualitative analysis identified psychosocial, discharge planning, and resource management issues affecting both COVID-positive and non-COVID patients, emphasizing the impact of social isolation. Integration of findings led to 5 consensus-based recommendations: adaptation of COVID unit environments, family involvement, socialization promotion, safe care trajectory planning and flexible local management. These findings highlight the need for balanced approaches between infection control and rehabilitation quality during healthcare crises, guided by local leadership.