Early Gait Responsiveness as a Predictor of Functional Trajectory in Older Adults Undergoing Postacute Rehabilitation

OBJECTIVE: To examine early gait responsiveness as a predictor of rehabilitation outcomes in older adults undergoing postacute rehabilitation. DESIGN: Retrospective cohort study. SETTING: Three skilled nursing facilities in Northern California. PARTICIPANTS: One hundred sixty-two adults aged ≥65 years admitted for postacute rehabilitation (2022-2023); 58% female; primary diagnoses: 38% orthopedic, 33% medical, and 28% neurologic. INTERVENTIONS: Not applicable (observational study). MAIN OUTCOME MEASURES: Discharge functional status (Functional Independence Measure motor subscale), length of stay, and discharge disposition. RESULTS: Early gait responsiveness was operationalized as the rate of change in gait distance across the first 5 physical therapy sessions. Mean early gait responsiveness was 2.1±1.6 m/session (range -0.6 to 7.4 m/session). Greater early gait responsiveness was independently associated with higher discharge functional status (β=2.6 per m/session; 95% confidence interval, [CI] 1.6-3.6), shorter length of stay (β=-2.0 d per m/session; 95% CI, -2.9 to -1.0), and increased odds of discharge home independently versus institutional placement (odds ratio=2.3; 95% CI 1.4-3.6). The addition of gait responsiveness improved model explanatory power beyond baseline function alone (R² 0.28-0.40). CONCLUSIONS: Early gait responsiveness is a clinically interpretable indicator of rehabilitation trajectory and may support earlier identification of patients at risk for suboptimal outcomes.