Impact of Therapist-Led Ward-Based Interprofessional Management on ADL Gains: A 3-Way Interaction With Rehabilitation Volume.

OBJECTIVES

Functional decline during acute-care hospitalization is a critical challenge. While rehabilitation volume influences recovery, the role of organizational factors is less defined. We examined whether therapist-led ward-based management modifies the association between conventional rehabilitation volume and activities of daily living (ADL) gain.

DESIGN

Multicenter retrospective observational cohort study.

SETTING AND

PARTICIPANTS

Data from 4166 consecutive patients across 18 acute-care wards in 9 Japanese hospitals.

METHODS

The primary outcome was ADL gain (Barthel Index change from admission to discharge). Ordinary least squares regression models with mean-centered continuous variables were employed to evaluate interaction patterns while adjusting for age, admission Barthel Index, and ward-level average length of stay per clinical specialty. We investigated the independent main effects, 2-way interactions, and the 3-way interaction among therapist-led ward management, weekday rehabilitation volume, and weekend rehabilitation volume.

RESULTS

While the main effect of ward management was not significant (P = .390), a significant positive 2-way interaction emerged between management and weekend rehabilitation volume (β = 0.968; P = .021). Furthermore, a significant 3-way interaction was observed among management, weekday, and weekend rehabilitation volume (β = 0.186; P = .005), with all variance inflation factors for interaction terms ≤5.05.

CONCLUSIONS AND IMPLICATIONS: Therapist-led ward management was not independently associated with ADL gain; however, significant interaction patterns were observed with weekday and weekend rehabilitation volume. In particular, the interaction with weekend rehabilitation volume suggests that ward-based management may support more consistent rehabilitation delivery across the week. These findings suggest that organizational ward-based management may influence how rehabilitation exposure is associated with functional recovery during acute-care hospitalization. Organizational strategies emphasizing structured interdisciplinary integration, rather than solely increasing therapy volume, may help support functional outcomes in hospitalized older adults.