Nurse-Led Motor Function Rehabilitation Program for Acute Ischemic Stroke: A Randomized Pilot Study

Abstract

Background Rehabilitation care for patients with stroke in the acute stage must be strengthened. However, the evidence on how to strengthen this care is insufficient. Purpose This article was designed to evaluate the feasibility and effectiveness of implementing a nurse-led motor function rehabilitation program on patients with acute ischemic stroke. Methods From January to October 2018, patients with initial acute ischemic stroke were assigned to one of two groups using a pilot randomized controlled trial design, with one group receiving a nurse-led motor function intervention program developed based on Orem's theory (7 consecutive days, twice daily for 30 minutes, experimental group) and the other receiving usual care (control group). The effectiveness measures included changes in the Motor Assessment Scale, the modified Barthel Index, and the National Institutes of Health Stroke Scale. The feasibility measures included patient retention rate, incidence of adverse events, and acceptance of nurses and patients. Results We assigned 104 patients (male: 55.7%; age: 62.8 ± 13.2 years) to receive either a nurse-led motor function rehabilitation program or usual care. Eighty-eight patients were evaluated after 7 days (87% retention rate), including 43 (83% retention rate) in the experimental group. Patients accepted the intervention well, and no severe adverse events were reported. Nurses had good fidelity and showed high acceptance. The experimental group showed significantly higher postintervention Motor Assessment Scale and modified Barthel Index scores than the control group (p < .001), whereas postintervention National Institutes of Health Stroke Scale scores did not differ significantly between the two groups. Conclusions/Implications for Practice The nurse-led rehabilitation program used in this study was shown to be feasible and effective in improving motor function in patients with acute ischemic stroke. Further study is recommended to determine related clinical recommendations.

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“…Such teams are directed by physicians trained in physical medicine and rehabilitation (physiatrists) or by neurologists who have specialized training or board certification in rehabilitation medicine. Other health professionals who play an essential role in the process include social workers, psychologists, psychiatrists, and counselors [5,6].…”

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“…The second implication is that a combination of additional training is effective in improving patients’ ADL. Previous studies on the content of additional training have reported the effectiveness of therapist-led self-exercise ( 15 ) and the introduction of a nurse-led exercise intervention programme ( 17 , 18 ). However, it was unclear which type of exercise was more effective and the combined effects of these additional training approaches remained ambiguous.…”

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“…Our literature search initially found 821 studies: 467 studies were omitted as duplicates, leaving 354 studies that were screened for relevancy. We finally included a total of 16 studies (Langhorne et al, 2010;Kim, 2012;Yue et al, 2013;McAlister et al, 2014;Wong and Yeung, 2015;Zhou et al, 2019;Ademuyiwa and Okubadejo, 2021;Li et al, 2021;Wang et al, 2021Wang et al, , 2022aAi et al, 2022;Cha et al, 2022;Deng et al, 2022;Urcan and Kolcu, 2022;Zheng et al, 2023). Out of them 12 were chosen for SR and MA (Langhorne et al, 2010;Yue et al, 2013;McAlister et al, 2014;Wong and Yeung, 2015;Zhou et al, 2019;Li et al, 2021;Wang et al, 2021Wang et al, , 2022aAi et al, 2022;Cha et al, 2022;Deng et al, 2022;Zheng et al, 2023), contrary to four studies that were only eligible for SR (Kim, 2012;Ademuyiwa and Okubadejo, 2021;Urcan and Kolcu, 2022;Wang et al, 2022b).…”

“…Our study finally included a total of 16 studies with overall 2072 enrolled patients; the studies were primarily clinical trials (Langhorne et al, 2010;Kim, 2012;Yue et al, 2013;McAlister et al, 2014;Wong and Yeung, 2015;Zhou et al, 2019;Li et al, 2021;Wang et al, 2021Wang et al, , 2022aAi et al, 2022;Cha et al, 2022;Urcan and Kolcu, 2022) in addition to only one cohort study (Deng et al, 2022) and two quasiexperimental studies (Ademuyiwa and Okubadejo, 2021;Zheng et al, 2023). The included studies were conducted in China, Canada, Australia, Sweden, Nigeria, the UK, and South Korea.…”

“…Published literature suggested that nurse-led stroke management was reported with either a positive effect of the nurse-led programs or a nonsignificant effect between the studies' arms. Additionally, no previous meta-analysis (MA) investigated the nurse-led programs versus the usual care concerning the management of post-stroke patients (Langhorne et al, 2010;Yue et al, 2013;McAlister et al, 2014;Wong and Yeung, 2015;Zhou et al, 2019;Li et al, 2021;Wang et al, 2021Wang et al, , 2022aAi et al, 2022;Cha et al, 2022;Deng et al, 2022;Zheng et al, 2023).…”