But without the EXACT PROTOCOL used and where it is located, you did useless research!
Effect of PDCA-optimized good limb positioning on hemiparetic rehabilitation outcomes in acute cerebral infarction
Wei Liu†
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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