A randomized controlled trial on rehabilitation through caregiver-delivered nurse-organized service programs for disabled stroke patients in rural china (the RECOVER trial): design and rationale Mapping patients’ experiences after stroke onto a patient-focused intervention framework Multidisciplinary transmural rehabilitation for older persons with a stroke: the design of a randomised controlled trial Effects of a nurse-led acupressure programme for stroke patients in China. Effectiveness of two rehabilitation strategies provided by nurses for stroke patients in Mexico. Methodology of the Stroke Self-Management Rehabilitation Trial: an international, multisite pilot trial. Trial and error versus errorless learning of functional skills in patients with acute stroke. Controlled Education of patients after Stroke (CEOPS)- nurse-led multimodal and long-term interventional program involving a patient’s caregiver to optimize secondary prevention of stroke: study protocol for a randomized controlled trial From rehabilitation to recovery: protocol for a randomised controlled trial evaluating a goal-based intervention to reduce depression and facilitate participation post-stroke Effectiveness of a strength-oriented psychoeducation on caregiving competence, problem-solving abilities, psychosocial outcomes and physical health among family caregiver of stroke survivors: A randomised controlled trial. Tracking patterns of needs during a telephone follow-up programme for family caregivers of persons with stroke Structured Nursing Intervention Versus Routine Rehabilitation After Stroke Development of a neurological rehabilitation environment: an observational study Observation and execution of upper-limb movements as a tool for rehabilitation of motor deficits in paretic stroke patients: protocol of a randomized clinical trial The Comprehensive Post-Acute Stroke Services (COMPASS) study: design and methods for a cluster-randomized pragmatic trial Comparison of rehabilitation practice on hospital wards for stroke patients. FAmily-Led RehabiliTaTion aftEr Stroke in INDia: The ATTEND Pilot Study
Rationale Stroke is the leading cause of death and disability in rural China . For stroke patients residing in re source -limited rural areas , secondary prevention and rehabilitation are largely unavailable , and where present , are far below evidence -based st and ards . Aim This study aims to develop and implement a simplified stroke rehabilitation program that utilizes nurses and family caregivers for service delivery , and evaluate its feasibility and effectiveness in rural China . Methods and design This 2-year r and omized controlled trial is being conducted in 2–3 county hospitals located in northwest , northeast , and southwest China . Eligible and consenting stroke in patients ( 200 in total ) have been recruited and r and omized into either a control or intervention group . Nurses in the county hospital are trained by rehabilitation specialists and in turn train the family caregivers in the intervention group . They also provide telephone follow-up care three times post discharge . The recruitment , baseline , intervention , follow-up care , and evaluation are guided by the RECOVER mobile phone app specifically design ed for this study . Study outcome The primary outcome is patients ’ Barthel Index ( activities of daily living : mobility , self-care , and toileting ) at 6 months . Process and economic evaluation will also be conducted . Discussion The results of our study will generate initial high- quality evidence to improve stroke care in re source -scarce setting s. If proven effective , this innovative care delivery model has the potential to improve the health and function of stroke patients  , relieve caregiver burden , guide policy-making , and advance translational research in the field of stroke care Background : Stroke patients ’ involvement in the rehabilitation process including decision making has made significant advances clinical ly over the past two decades . However , development of patient-focused interventions in stroke rehabilitation is a relatively under developed area of research . The aim of this study was to interpret the explanations that patients gave of their experience after stroke and how these may vali date an already established patient-focused intervention framework – the Quest for quality and improved performance ( QQUIP ) ( 2006 ) that includes seven quality improvement goals . Methods : A r and om purposive sample of eight stroke patients was interviewed between 3 and 6 months following discharge . Patients ’ reports of their experience after stroke were obtained using in-dept semi-structured interviews and analysed using Qualitative Content Analysis . Results : Explanations given by patients included both positive and negative reports of the stroke experience . Regardless of consequences as a result of physical , psychological and social impairments , there were other life style disruptions that were reported by all patients such as taking new medication and adverse effects of these , experiencing increasing fatigue , difficulties with social activities and situations and having to make changes in health behaviours and lifestyle . Some of the core themes that emerged reflected the aims of QQUIP improvement goals that include improving health literacy , clinical decision-making , self-care , patient safety , access to health advice , care experience and service development . Discussion : Further recommendations based on the findings from this study would be to consider using the QQUIP framework for developing intervention studies in stroke rehabilitation care that are person-centred . This framework provides a template that is equipped to address some of the main concerns that people have following the experience of stroke and also focuses on improving quality of care . Implication s for Rehabilitation Consideration for the use of established patient focused frameworks for improving the design and development of rehabilitation stroke interventions . Identify patients ’ main concerns following the experience of stroke and its result ing consequences in developing stroke rehabilitation interventions Greater need to move from a provider-led model of care towards a more favourably balanced view that includes patient participation and involvement in their self management of the rehabilitation programme Background Stroke is one of the major causes of loss of independence , decreased quality of life and mortality among elderly people . About half of the elderly stroke patients discharged after rehabilitation in a nursing home still experience serious impairments in daily functioning one year post stroke , which can lead to difficulties in picking up and managing their social life . The aim of this study is to evaluate the effectiveness and feasibility of a new multidisciplinary transmural rehabilitation programme for older stroke patients . Methods A two group multicentre r and omised controlled trial is used to evaluate the effects of the rehabilitation programme . The programme consists of three care modules : 1 ) neurorehabilitation treatment for elderly stroke patients ; 2 ) empowerment training for patient and informal caregiver ; and 3 ) stroke education for patient and informal caregiver . The total programme has a duration of between two and six months , depending on the individual problems of the patient and informal caregiver . The control group receives usual care in the nursing home and after discharge .  Patients aged 65 years and over are eligible for study participation when they are admitted to a geriatric rehabilitation unit in a nursing home due to a recent stroke and are expected to be able to return to their original home environment after discharge . Data are gathered by face-to-face interviews , self-administered question naires , focus groups and registration forms . Primary outcomes for patients are activity level after stroke , functional dependence , perceived quality of life and social participation . Outcomes for informal caregivers are perceived care burden , objective care burden , quality of life and perceived health . Outcome measures of the process evaluation are implementation fidelity , programme deliverance and the opinion of the stroke professionals , patients and informal caregivers about the programme . Outcome measures of the economic evaluation are the healthcare utilisation and associated costs . Data are collected at baseline , and after six and 12 months . The first results of the study will be expected in 2014.Trial registration International St and ard R and omised Controlled Trial Register Number IS RCT N62286281 , The Dutch Trial Register AIM AND OBJECTIVE To examine the effects of a nurse-led acupressure programme on the recovery of motor function and daily activities of stroke patients . BACKGROUND Stroke is one of the main causes of death and permanent physical disability in the world . The traditional Chinese medicine ( TCM ) is widely used for the treatment and rehabilitation of people with stroke in China . Physiotherapy or occupational therapy can not be performed several times a day . Therefore , research ers and healthcare providers have been seeking effective and efficient alternative strategies for the rehabilitation of stroke patients . Acupressure , non-invasive and widely accessible to any healthcare professionals , is one of the promising alternatives . METHODS Seventy-eight stroke patients were recruited and r and omly assigned into an intervention or control group , with 39 patients in each . The intervention group received acupressure plus routine care , while the control group received only routine care only . The acupressure treatment was carried out by nurses . Patient 's activities of daily living ( ADL ) and motor function from both groups were evaluated at the point of recruitment , and at the end of the first and third month after stroke . RESULTS The ADL and the Fugl-Meyer motor scores in the intervention group were significantly higher than those in the control group at the end of the third month ( p<0.05 ) . CONCLUSION Nurse-led acupressure programme had positive effects on the recovery of motor function and daily activities of stroke patients . Our study suggests that nurse-led acupressure programmes play an important role in the recovery of stroke patients . RELEVANCE TO CLINICAL PRACTICE Healthcare providers need to think about alternative care methods including acupressure for the rehabilitation of stroke patients . Acupressure is one of the promising alternatives nursing intervention for stroke patients in practice OBJECTIVE Rehabilitation strategies have been developed to improve functional state in stroke patients . The main objective of this study was to evaluate the effectiveness of the early rehabilitation at hospital and its continuity at home provided by nurses , on the functional recovery of basic and social activities in stroke patients compared with conventional care . DESIGN A r and omised clinical trial was carried out in three general hospitals of the Mexican Institute of Social Security ( IMSS ) in Mexico City between April 2003-May 2004 . PARTICIPANTS Stroke patients . METHODS Two rehabilitation strategies provided by nurses for stroke patients were compared : physiotherapy plus caregiver education in rehabilitation ( strategy 1 , S1 ) vs. education alone ( strategy 2 , S2 ) . The main outcome variables were the basic ( Barthel index ) and social ( Frenchay activities index ) activities of daily living , of each patient . Age , sex , morbidity , stroke symptoms , complications , neurological damage ( Canadian Scale ) , cognitive state ( mini-mental state examination question naire ) and duration of hospitalisation were defined as the control variables . Patients were evaluated at baseline and months one , three and six thereafter . RESULTS One hundred and ten patients with ischaemic stroke were enrolled and r and omised ; 59 were assigned to S1 and 51 to S2 . Comparison of the outcome variables showed that patients improved significantly over time , but no differences were observed between groups . We observed no significant difference in strategy performance with regard to the basic and instrumental activities of daily living . RELEVANCE TO CLINICAL PRACTICE Participants who received physiotherapy with additional caregiver education benefit no more than those whose caregivers received education alone . Those countries that do not have integral rehabilitation programmes for stroke patients should underst and their importance and budget re sources for them . Meanwhile , both caregiver education and nurses trained in specific care and physiotherapy are alternatives that benefit these patients RATIONALE Stroke is a major cause of long-term adult disability with many survivors living in the community relying on family members for on-going support . However , reports of inadequate underst and ing of rehabilitation techniques are common . A self-management DVD-based observational learning tool may help improve functional outcomes for survivors of stroke and reduce caregivers ' burden . AIMS This article describes the methodology of the stroke self-management rehabilitation trial . The overall aim of this pilot trial is to assess the feasibility and preliminary efficacy of a DVD-based intervention for improving functional outcomes of survivors of stroke 2 months postr and omization to inform the design of a full-scale r and omized clinical trial . DESIGN Recruitment of a minimum of 20 survivors of stroke and their informal caregivers ( where available ) in each of the participating centers will occur across multiple international sites . After baseline assessment s , participants will be r and omly assigned to an intervention or st and ard care group . The intervention comprises a structured DVD observation and practice schedule over 8 weeks . All participants will complete follow-up assessment s. STUDY OUTCOMES The outcome measures will include a global shift in the Rankin Scale scores and dichotomized scores , changes in quality of life , general health , depression , and caregiver burden at 2 months postr and omization . A qualitative analysis of the effects of the intervention will also be undertaken . DISCUSSION The results of the pilot study will provide knowledge of whether observational learning techniques delivered via DVD can effectively improve recovery after stroke and reduce caregiver burden OBJECTIVE To compare the effectiveness of errorless learning versus trial and error learning for teaching activities of daily living to patients with acute stroke with or without explicit memory impairments . DESIGN R and omized crossover . SETTING Rehabilitation hospital . PARTICIPANTS Thirty-three adult subjects following an acute stroke . INTERVENTION Subjects were taught to prepare a wheelchair for a transfer and to put on a sock with a sock-donner . Tasks were taught using errorless learning or trial and error learning .  Explicit memory was assessed using the Neurobehavioral Cognitive Status Exam . MAIN OUTCOME MEASURES Days until subject was able to demonstrate retention of the task , and success or failure at carry-over to a similar task . RESULTS No significant differences were found in days to retention for either functional task when taught using errorless learning or trial and error learning in subjects with or without explicit memory impairments . Carry-over was significantly better when trial and error learning was used for learning sock donning . CONCLUSIONS When choosing the best learning method for patients undergoing rehabilitation for stroke , the nature of the task should be considered . Additional research is needed to identify the best approach for teaching activities of daily living and facilitating carry-over of learning in individuals with acute stroke Background Setting up a follow-up secondary prevention program after stroke is difficult due to motor and cognitive impairment , but necessary to prevent recurrence and improve patients ’ quality of life . To involve a referent nurse and a caregiver from the patient ’s social circle in nurse-led multimodal and long-term management of risk factors after stroke could be an advantage due to their easier access to the patient and family . The aim of this study is to compare the benefit of optimized follow up by nursing personnel from the vascular neurology department including therapeutic follow up , and an interventional program directed to the patient and a caregiving member of their social circle , as compared with typical follow up in order to develop a specific follow-up program of secondary prevention of stroke . Methods / design The design is a r and omized , controlled , clinical trial conducted in the French Stroke Unit of the Strokavenir network . In total , 410 patients will be recruited and r and omized in optimized follow up or usual follow up for 2 years . In both group , patients will be seen by a neurologist at 6 , 12 and 24 months . The optimized follow up will include follow up by a nurse from the vascular neurology department , including therapeutic follow up , and a training program on secondary prevention directed to the patient and a caregiving member of their social circle . After discharge , a monthly telephone interview , in the first year and every 3 months in the second year , will be performed by the nurse . At 6 , 12 and 24 month , the nurse will give the patient and caregiver another training session . Usual follow up is only done by the patient ’s general practitioner , after classical information on secondary prevention of risk factors during hospitalization . The primary outcome measure is blood pressure measured after the first year of follow up . Blood pressure will be measured by nursing personnel who do not know the group into which the patient has been r and omized . Secondary endpoints are associated mortality , morbidity , recurrence , drug side-effects and medico-economic analysis . Discussion The result of this trial is expected to provide the benefit of a nurse-led optimized multimodal and long-term interventional program for management of risk factors after stroke , personalizing the role of the nurse and including the patient ’s caregiver . Trial registration Clinical Trials.gov , NCT 02132364 . Registered on 7 May 2014 . EUDRACT , A 00473 - 40 Background There is much discourse in healthcare about the importance of client-centred rehabilitation , however in the realm of community-based therapy post-stroke there has been little investigation into the efficacy of goal -directed practice that reflects patients ' valued activities . In addition , the effect of active involvement of carers in such a rehabilitation process and their subsequent contribution to functional and emotional recovery post-stroke is unclear . In community based rehabilitation , interventions based on patients ' perceived needs may be more likely to alter such outcomes . In this paper , we describe the methodology of a r and omised controlled trial of an integrated approach to facilitating patient goal achievement in the first year post-stroke . The effectiveness of this intervention in reducing the severity of post-stroke depression , improving participation status and health-related quality of life is examined . The impact on carers is also examined . Methods / Design Patients ( and their primary carers , if available ) are r and omly allocated to an intervention or control arm of the study . The intervention is multimodal and aims to screen for adverse stroke sequelae and address ways to enhance participation in patient-valued activities . Intervention methods include : telephone contacts , written information provision , home visitation , and contact with treating health professionals , with further relevant health service referrals as required . The control involves treatment as usual , as determined by inpatient and community rehabilitation treating teams . Formal blinded assessment s are conducted at discharge from inpatient rehabilitation , and at six and twelve months post-stroke . The primary outcome is depression . Secondary outcome measures include participation and activity status , health-related quality of life , and self-efficacy . Discussion The results of this trial will assist with the development of a model for community-based rehabilitation management for stroke patients and their carers , with emphasis on goal -directed practice to enhance home and community participation status . Facilitation of participation in valued activities may be effective in reducing the incidence or severity of post-stroke depression , as well as enhancing the individual 's perception of their health-related quality of life . The engagement of carers in the rehabilitation process will enable review of the influence of the broader social context on recovery . Trial registration Australia and New Zeal and Clinical Trials Register ( ANZCTR ) : BACKGROUND Family caregivers provide the foundation for long-term home care of stroke survivors . The overwhelming stress associated with caregiving hinders the ability of family caregivers to utilise their internal and external re sources to cope with this situation , thereby placing their own health at risk . We conducted a r and omised controlled trial of a strength-oriented psychoeducational programme on conventional stroke rehabilitation for family caregivers . OBJECTIVES To evaluate the effectiveness of a strength-oriented psychoeducational programme on the caregiving competence , problem-solving coping abilities , caregiver 's depressive symptoms , caregiving burden and re sources ( family functioning , social support ) and physical health ( such as caregiving-related injury ) , as well as potential placement of stroke survivors . DESIGN A prospect i ve multi-centre and single-blinded r and omised controlled trial stratified by survivors ' history of stroke . SETTING AND PARTICIPANTS Adult stroke patients and their family caregivers were recruited from the medical wards of a regional acute and two rehabilitation hospitals in the Eastern New Territories of Hong Kong . METHODS The design of the trial was based on the relational/problem-solving model . Family caregivers of stroke survivors who had been admitted to the study hospitals completed a set of question naires before r and omisation , immediately , one- and three-months post-intervention . The control group received usual care , whereas the intervention group received an additional 26-week strength-oriented psychoeducational programme ( two structured individual face-to-face pre-discharge education sessions on stroke and its associated caregiving skills and six biweekly post-discharge telephone-based problem-solving coping skills training sessions ) . Data were analysed using the generalized estimating equation and multiple regression models and chi-square tests . RESULTS We recruited 128 caregiver-survivor dyads . The intervention group demonstrated significantly greater improvements throughout the study ( p < 0.01 ) in terms of caregiving competence , problem-solving coping abilities and social support satisfaction . This group also displayed significantly greater improvements in terms of family functioning ( p < 0.05 ) at one-month post-intervention , an increased number of social support ( p < 0.001 ) and a lower level of burden at three-month post-intervention . However , there was no significant effect on enabling stroke survivors to remain in their home . Post-hoc analysis showed a significant and indirect effect of problem-solving coping abilities , which suggested its mediating effect on caregiving competence of stroke caregivers . CONCLUSIONS Findings suggest that incorporating a strength-oriented psychoeducational programme into the existing stroke rehabilitation protocol can foster a healthy transition to caregiving among family members of stroke survivors Abstract Purpose : Programmes that address stroke family caregiver needs and skill-building are recommended based on the literature and patient care guidelines for stroke rehabilitation . The purpose of this study was to explore patterns of perceived needs and skill-building during a  stroke caregiver intervention programme . Method : Descriptive statistics were used to analyse data from 123 stroke caregivers enrolled in the intervention group of a r and omised controlled clinical trial . Caregivers received eight weekly telephone sessions , with a booster session a month later . At each session , the  Caregiver Needs and Concerns Checklist ( CNCC ) was used to identify and prioritise current needs that were then addressed through skill-building strategies . Results : Perceived needs changed over time . Information about stroke was the highest priority need during Session 1 . Managing survivor emotions and behaviours was the highest priority for Sessions 2 through 4 . Caregivers generally waited until Sessions 5 through 9 to address their own emotional and physical health needs . Physical and instrumental care needs were relatively low but stable across all nine sessions . Skill-building was consistently high , though it peaked during Sessions 2 and 3 . Conclusions : Tracking patterns of needs and skill-building suggest appropriate timing for targeting different types of family caregiver support during stroke rehabilitation . Implication s for Rehabilitation Family caregivers of stroke survivors play an essential role in the rehabilitation process of the stroke survivor . Identifying and addressing the priority needs and concerns of stroke caregivers during the early discharge period enables caregivers to provide sustained support for the stroke survivor . Rehabilitation professionals are in a key position to address evolving caregiver needs and concerns as they transition to home setting s with follow-up care Nir Z , Zolotogorsky Z , Sugarman H : Structured nursing intervention versus routine rehabilitation after stroke . Am J Phys Med Rehabil 2004;83:522–529 . Objective : The goal of this study was to examine the effect of a structured , comprehensive nursing intervention on the course of rehabilitation over the first 6 mos after a first-ever stroke . Design : Intervention ( experimental ) study . The participants were 155 elderly stroke survivors who were admitted to a geriatric rehabilitation department . Stratified r and om sampling generated intervention and control groups . The intervention was design ed to work together with the routine rehabilitation program and consisted of 12 consecutive weekly meetings . The control group received only the routine rehabilitation program . Study variables were measured at entry to study and after 3- and 6-mo intervals . Results : Although there were no significant differences between the two groups at entry to study , at 3 and 6 mos after stroke , the intervention group showed better scores than the control group in functional status ( FIM ™ instrument ) , depression ( Geriatric Depression Scale ) , self-perceived health , self-esteem , and dietary adherence . Conclusion : The nursing intervention had both short- and long-term effects on functional , psychological , and emotional variables . Serious consideration should be given to implementing comprehensive nursing interventions during rehabilitation tailored to meet the specific needs of stroke survivors and their caregivers Background : Engagement in therapeutic activity among stroke in patients is advocated by many rehabilitation professionals . However , there is a lack of published evidence to indicate whether this is currently being achieved . Objective : To investigate the extent and types of ' rehabilitation ' activities on a new neurological rehabilitation ward , and examine change in patients ' behaviour related to the new environment and new initiatives . Design : Five one-week observation periods were conducted over two years , with a total of 67 patients being observed . A comparison was made with results of an earlier study of stroke patients ' activities conducted at the same hospital . Results : Patients spent an average 43 min per day with therapists  ( 9 % of the working day ) and this was only marginally supplemented by  self-exercise  ( 2 % of the working day - approximately 10 min ) . However , the provision of a new rehabilitation environment was associated with a marked decrease in the time patients spent at their bedsides , and a decrease in time spent passively gazing or watching others . Conclusions : Overall there was some positive change in patients ' behaviour . We suggest that structured guidance is required from the whole multidisciplinary team to stimulate more self-directed therapy practice and recreation Background Evidence exist that motor observation activates the same cortical motor areas that are involved in the performance of the observed actions . The so called “ mirror neuron system ” has been proposed to be responsible for this phenomenon . We employ this neural system and its capability to re-enact stored motor representations as a tool for rehabilitating motor control . In our new neurorehabilitative schema ( videotherapy ) we combine observation of daily actions with concomitant physical training of the observed actions focusing on the upper limbs . Following a pilot study in chronic patients in an ambulatory setting , we currently design ed a new multicenter clinical study dedicated to patients in the sub-acute state after stroke using a home-based self-induced training .  Within our protocol we assess 1 ) the capability of action observation to elicit rehabilitational effects in the motor system , and 2 ) the capacity of this schema to be performed by patients without assistance from a physiotherapist . The results of this study would be of high health and economical relevance . Methods / design A controlled , r and omized , multicenter , paralleled , 6 month follow-up study will be conducted on three groups of patients : one group will be given the experimental treatment whereas the other two will participate in control treatments .  All patients will undergo their usual rehabilitative treatment beside participation in the study . The experimental condition consists in the observation and immediate imitation of common daily h and and arm actions . The two parallel control groups are a placebo group and a group receiving usual rehabilitation without any trial-related treatment . Trial r and omization is provided via external data management . The primary efficacy endpoint is the improvement of the experimental group in a st and ardized motor function test ( Wolf Motor Function Test ) relative to control groups . Further assessment s refer to subjective and qualitative rehabilitational scores . This study has been review ed and approved by the ethics committee of Aachen University . Discussion This therapy provides an extension of therapeutic procedures for recovery after stroke and emphasizes the importance of action perception in neurorehabilitation The results of the study could become implemented into the wide physiotherapeutic practice , for example as an ad on and individualized therapy Background Patients discharged home after stroke face significant challenges managing residual neurological deficits , secondary prevention , and pre-existing chronic conditions . Post-discharge care is often fragmented leading to increased healthcare costs , readmissions , and sub-optimal utilization of rehabilitation and community services . The COMprehensive Post-Acute Stroke Services ( COMPASS ) Study is an ongoing cluster-r and omized pragmatic trial to assess the effectiveness of a comprehensive , evidence -based , post-acute care model on patient-centered outcomes . Methods Forty-one hospitals in North Carolina were r and omized ( as 40 units ) to either implement the COMPASS care model or continue their usual care . The recruitment goal is 6000 patients ( 3000 per arm ) . Hospital staff ascertain and enroll patients discharged home with a clinical diagnosis of stroke or transient ischemic attack . Patients discharged from intervention hospitals receive 2-day telephone follow-up ; a comprehensive clinic visit within 2 weeks that includes a neurological evaluation , assessment s of social and functional determinants of health , and an individualized COMPASS Care Plan ™ integrated with a community-specific re source data base ; and additional follow-up calls at 30 and 60 days post-stroke discharge . This model is consistent with the Centers for Medicare and Medicaid Services transitional care management services provided by physicians or advanced practice providers with support from a nurse to conduct patient assessment s and coordinate follow-up services . Patients discharged from usual care hospitals represent the control group and receive the st and ard of care in place at that hospital . Patient-centered outcomes are collected from telephone surveys administered at 90 days . The primary endpoint is patient-reported functional status as measured by the Stroke Impact Scale 16 . Secondary outcomes are : caregiver strain , all-cause readmissions , mortality , healthcare utilization , and medication adherence . The study engages patients , caregivers , and other stakeholders ( including policymakers , advocacy groups , payers , and local community coalitions ) to advise and support the design , implementation , and sustainability of the COMPASS care model . Discussion Given the high societal and economic burden of stroke , identifying a care model to improve recovery , independence , and quality of life is critical for stroke survivors and their caregivers . The pragmatic trial design provides a real-world assessment of the COMPASS care model effectiveness and will facilitate rapid implementation into clinical practice if successful . Trial registration Clinical trials.gov : NCT02588664 ; October 23 , 2015 BACKGROUND AND PURPOSE The aim of the study was to observe patients on a stroke unit  and to compare their activity with that of patients on conventional hospital wards to identify aspects of rehabilitation practice that might account for differences in outcome . METHODS Stroke patients admitted to the hospital were observed on three 8-hour shifts over 3 consecutive days . An observer recorded , at 10-minute intervals , where patients were , what they were doing , and whether their positioning was as recommended by rehabilitation therapists .  Patients on a  stroke unit  were compared with those on conventional wards . RESULTS Stroke unit patients spent less time by their beds and more time in other locations on the ward ( P < .001 ) . There were significant differences in the frequency of behaviors observed in the two types of ward ( P < .001 ) . Stroke unit patients had significantly more interaction with nurses and therapists ( P < .001 ) . They were also more often in the recommended position ( P < .001 ) . CONCLUSIONS The proportion of time in therapeutic activity  was low in all locations , with patients spending many hours sitting and doing nothing . Despite this , stroke unit patients had more therapeutic contact with staff and were more often in the recommended position . These two features may account for some of the differences in outcome Background The aim of this pilot study was to determine the feasibility of a multicenter , r and omized , controlled trial in India of a family-led , trained caregiver-delivered , home-based rehabilitation intervention vs. routine care . Methods A prospect i ve , r and omized ( within seven-days of hospital admission ) , blinded outcome assessor , controlled trial of  structured home-based rehabilitation delivered by trained and protocol -guided family caregivers ( intervention ) vs. routine care alone ( control ) was conducted in patients with residual disability . Key feasibility measures were recruitment , acceptance and adherence to assessment procedures , and follow-up of participants over six-months . CTRI/2014/10/005133 . Results A total of 104 patients from the stroke unit at Christian Medical College , Ludhiana were recruited over nine-months .  Recruitment was feasible and accepted by patients and their carers . Important observations were made regarding potential unblinding of the participants , contamination of therapy between the r and omized groups , organization of home visits , and re sources required for a multicenter study . Conclusion The pilot study established the feasibility of conducting a large-scale study of family-led , trained caregiver-delivered , home-based stroke rehabilitation in a low re source setting . The main phase of the trial ‘ ATTEND ’ is currently underway in over 10 centers in India
RESULTS Studies of task-related training showed benefits for functional outcome compared with traditional therapies .
Active use of task-oriented training with stroke survivors will lead to improvements in functional outcomes and overall health-related quality of life .
CONCLUSION Generally , task-oriented rehabilitation proved to be more effective .
Many interventions are feasible for nurses and can be performed in a ward or at home .
AIM This paper is a report of a review conducted to provide an overview of the evidence in the literature on task-oriented training of stroke survivors and its relevance in daily nursing practice .
BACKGROUND Stroke is the second leading cause of death and one of the leading causes of adult disability in the Western world .
The use of neurodevelopmental treatment in the daily nursing care of stroke survivors does not improve clinical outcomes .
Nurses are therefore exploring other forms of rehabilitation intervention , including task-oriented rehabilitation .
Despite the growing number of studies showing evidence on task-oriented interventions , recommendations for daily nursing practice are lacking .