Introduction of Nurse-Led Rehabilitation Services for Patients With Stroke After Discharge to Improve Self-Care...

Stroke is a leading cause of disability and death, resulting in a clinical, social, and economic burden upon families and the health system worldwide.

This study aimed to introduce nurse-led rehabilitation services for patients after stroke to improve functional independence for self-care management.

A pilot, open-label, 2-arm (1:1), randomized controlled trial was conducted at the National Institute of Neuroscience & Hospital in Bangladesh between March and August 2025. A total of 64 patients with stroke were enrolled using simple randomization. In the intervention group (IG), patients received rehabilitation education and assistive devices to improve activities of daily living. The control group (CG) received usual hospital care for stroke. Data were collected through a structured questionnaire. After discharge from the hospital, study nurses enrolled patients after stroke after a face-to-face assessment and provided rehabilitation education at the hospital and monthly rehabilitative education at home for 3 months. The study outcomes were improvement of functional independence, self-efficacy, social participation and reduction of caregivers' burden.

Among 64 participants, 47 (73%) completed the study. Results depict an increase in self-care capacity, self-efficacy, social involvement and a decrease in care burden in both groups from baseline to end line; nevertheless, there was no statistically significant difference between IG and CG (F_{2, 44}=0.113; P=.74). Functional Independence Measure mean scores (IG: mean 78.4, SD 37.6; CG: mean 74.3, SD 35.4; P=.70; 95% CI -25.16 to 18.14), self-efficacy (IG: mean 27.0, SD 6.9; CG: mean 26.6, SD 7.1; P=.83; 95% CI -3.6 to 4.6), social participation (IG: mean 30.4, SD 21.4; CG: mean 28.2, SD 17.2; P=.61; 95% CI -9.33 to 13.61), and care burden (IG: mean 24.9, SD 13.6; CG: mean 25.2, SD 12.6; P=.83; 95% CI -8 to 7). In qualitative analysis, we noticed enhanced self-care capacities of patients with poststroke disabilities after rehabilitative intervention, as indicated by participants' perceptions.

In this study, patients' self-care capability was improved after the intervention from baseline, and improvements were noted by using assistive devices based on patients' perceptions and responses. The study findings demonstrated the importance of early self-care management for patients with poststroke disabilities. Future research should focus on long-term, community-integrated strategies that involve primary care, enhanced technological support, and caregiver-focused disability adjustment programs to achieve better outcomes.

ClinicalTrials.gov NCT06786559; https://clinicaltrials.gov/search?id=NCT06786559.