Guangyan Yao†Zhihui Song†
Xin He*†- Department of Neurology, Central Hospital Affiliated to Shandong First Medical University, Jinan, China
Background: Proper limb positioning plays a vital
role in the early rehabilitation of patients with acute cerebral
infarction (ACI), preventing complications such as muscle atrophy and
joint contractures while promoting functional recovery. However,
inconsistent implementation limits its effectiveness. This study
evaluates the impact of the Plan-Do-Check-Act (PDCA) cycle management
model in optimizing good limb positioning and improving rehabilitation
outcomes.
Methods: A prospective cohort study was conducted
involving 300 hemiplegic ACI patients, with 150 patients receiving
standard limb positioning care (control group) and 150 patients treated
using the PDCA-optimized protocol (intervention group). The study was
approved by The Ethics Committee of Central Hospital Affiliated to
Shandong First Medical University (approval number: 20241104006).
Outcomes included adherence rates, self-efficacy, quality of life
(SF-36), activities of daily living (ADL), and secondary complications
such as limb spasticity.
Results: The intervention group demonstrated significantly higher adherence rates (88.0% vs. 48.0%, p < 0.001) and improved rehabilitation outcomes, including increased self-efficacy (25.0 vs. 17.0, p < 0.001), better quality of life (66.5 ± 13.8 vs. 61.7 ± 17.2, p < 0.001), and enhanced ADL scores (62.2 ± 10.2 vs. 52.8 ± 9.9, p < 0.01). Median hospital stay was reduced (10 days vs. 12 days, p = 0.001), and limb spasticity incidence was lower in the intervention group (p = 0.001). No significant differences in discharge NIHSS scores were observed.
Conclusion: The PDCA cycle significantly enhances
the implementation of good limb positioning, improving functional
recovery, reducing secondary complications, and optimizing
rehabilitation timelines for ACI patients. This study highlights the
utility of PDCA in standardizing care practices and promoting better
clinical outcomes. Further research should explore its broader
application in diverse clinical settings.
Introduction
Acute Cerebral Infarction (ACI), a prevalent condition
among the middle-aged and elderly populations, is associated with high
mortality, recurrence, and disability rates (1).
Of those who survive, more than half experience varying degrees of
functional impairment. The most common functional deficits include
visual field defects, sensory and motor dysfunctions, speech and
swallowing difficulties, as well as cognitive and psychological
impairments (2).
Furthermore, ACI survivors often face shoulder problems and urinary or
bowel dysfunction. The rehabilitation process for ACI primarily targets
restoring motor, cognitive, speech, and functional abilities, with an
emphasis on improving the patient’s overall quality of life.
Among the various rehabilitation strategies, the
importance of good limb positioning has garnered significant recognition
in recent years. Clinical evidence supports that appropriate limb
positioning not only aids in the prevention of complications such as
muscle atrophy, shoulder-hand syndrome, and joint contractures, but also
contributes to reducing the severity of limb spasticity after stroke,
with studies showing a pooled prevalence of spasticity at 25.3% and
indicating that proper limb positioning can significantly lower
spasticity levels (3–5).
Early rehabilitation, especially within the first month after ACI onset
and thrombolysis, is crucial, as the brain exhibits higher plasticity
during this period (6).
For hospitalized ACI patients, early intervention plays a key role in
enhancing motor function in the affected limb, reducing common secondary
complications, and promoting favorable conditions for subsequent
rehabilitation during the recovery phase (7, 8).
However, despite the established benefits, the application of good limb
positioning remains inconsistent in clinical practice, often hindered
by a range of systemic, clinical, and environmental barriers. Many ACI
patients do not receive optimal early rehabilitation, which can
significantly impede functional recovery and the prevention of secondary
complications.
The Plan-Do-Check-Act (PDCA) cycle, a widely recognized
model for continuous quality improvement (CQI), has proven effective in
addressing such challenges in various healthcare settings (9).
Initially developed for business management, the PDCA framework has
since been adapted to healthcare quality management, offering a
structured approach to improving clinical practices and patient
outcomes. By systematically identifying problems, implementing targeted
interventions, monitoring progress, and refining strategies, the PDCA
cycle has become a cornerstone in hospital management, achieving
substantial improvements in patient care (10, 11).
In the context of ACI rehabilitation, the PDCA framework can be
particularly beneficial in optimizing the application of good limb
positioning. In our institution, we have identified several obstacles
that hinder the effective implementation of this rehabilitation
technique, including insufficient multidisciplinary collaboration,
inadequate training, and a lack of standardization in the approach. As a
result, early rehabilitation therapy remains underutilized,
particularly for ACI patients in the neurology department.
This study is the first to explore the application of the
PDCA management model in optimizing good limb positioning for early
functional recovery in hemiplegic patients following acute cerebral
infarction ACI. The findings of this study may provide valuable insights
into how quality improvement initiatives can be effectively integrated
into rehabilitation protocols for ACI patients, offering a pathway to
better recovery and long-term functional independence.
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