Accepted for/Published in: JMIR Rehabilitation and Assistive Technologies
Date Submitted: Dec 2, 2025
Date Accepted: Jul 2, 2026
Introduction of Nurse-Led Rehabilitation Services for Post-Discharge Stroke Patients to Improve Self-care Management in Bangladesh: A Pilot Randomized Controlled Trial
ABSTRACT
Background:
Stroke is a leading cause of disability and death, which results in clinical, social and economic burden upon family and health system worldwide.
Objective:
This study aimed to introduce nurse-led rehabilitation services for post-stroke patients to improve functional independence for self-care management.
Methods:
A pilot, open-label, two-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 stroke patients were enrolled using simple randomization. In the intervention group, patients received rehabilitation education and assistive devices to improve activities of daily living (ADL). The control group received hospital usual care for stroke. Data were collected through a structured questionnaire. After discharge from the hospital, study nurses enrolled post-stroke patients 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.
Results:
Among 64 participants, 47 (73%) completed the study. Result depicts an increase of self-care capacity, self-efficacy, social involvement and decrease care burden in both groups from baseline to endline; nevertheless, there was no statistically significant difference between IG and CG (F = 0.113, P = 0.74). FIM mean scores [IG: 78.4 ± 37.6, CG: 74.3±35.4, P = 0.7; 95% CI (-25.16, 18.14)], self-efficacy [IG: 27.0 ± 6.9, CG: 26.6 ± 7.1; P = 0.83; 95% CI (-3.6, 4.6)], social participation [IG: 30.4 ± 21.4, CG: 28.2 ± 17.2; P = 0.61; 95% CI (-9.33, 13.61)] and care burden [IG: 24.9 ± 13.6, CG: 25.2 ± 12.6, P = 0.83; 95% CI (-8, 7)]. In qualitative analysis, we noticed enhanced self-care capacities of disabled stroke patients after rehabilitative intervention as indicated by participants’ perceptions.
Conclusions:
In this study, patients' self-care capability was improved after intervention from baseline, and improvements were noted by using assistive devices based on patients' perceptions and responses. This study findings guaranteed the importance of early self-care management of the post-stroke disabled patients. 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. Clinical Trial: ClinicalTrials.gov NCT06786559
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