Liu Wei, Yao Guangyan, Song Zhihui, He Xin
Department of Neurology, Central Hospital Affiliated to Shandong First Medical University, Jinan, China.
Front Neurol. 2025 Jun 6;16:1554384. doi: 10.3389/fneur.2025.1554384. eCollection 2025.
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.
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.
The intervention group demonstrated significantly higher adherence rates (88.0% vs. 48.0%, < 0.001) and improved rehabilitation outcomes, including increased self-efficacy (25.0 vs. 17.0, < 0.001), better quality of life (66.5 ± 13.8 vs. 61.7 ± 17.2, < 0.001), and enhanced ADL scores (62.2 ± 10.2 vs. 52.8 ± 9.9, < 0.01). Median hospital stay was reduced (10 days vs. 12 days, = 0.001), and limb spasticity incidence was lower in the intervention group ( = 0.001). No significant differences in discharge NIHSS scores were observed.
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.
正确的肢体摆放对急性脑梗死（ACI）患者的早期康复起着至关重要的作用，可预防肌肉萎缩和关节挛缩等并发症，同时促进功能恢复。然而，实施过程不一致限制了其效果。本研究评估计划-执行-检查-行动（PDCA）循环管理模式在优化良肢位摆放及改善康复结局方面的影响。
进行一项前瞻性队列研究，纳入300例偏瘫ACI患者，150例患者接受标准肢体摆放护理（对照组），150例患者采用PDCA优化方案治疗（干预组）。本研究经山东第一医科大学附属中心医院伦理委员会批准（批准文号：20241104006）。结局指标包括依从率、自我效能感、生活质量（SF-36）、日常生活活动能力（ADL）以及肢体痉挛等继发性并发症。
干预组的依从率显著更高（88.0%对48.0%，<0.001），康复结局得到改善，包括自我效能感增强（25.0对17.0，<0.001）、生活质量提高（66.5±13.8对61.7±17.2，<0.001）以及ADL评分提高（62.2±10.2对52.8±9.9，<0.01）。干预组的中位住院时间缩短（10天对12天，=0.001），肢体痉挛发生率更低（=0.001）。出院时美国国立卫生研究院卒中量表（NIHSS）评分无显著差异。
PDCA循环显著提高了良肢位摆放的实施效果，改善了功能恢复，减少了继发性并发症，并优化了ACI患者的康复时间线。本研究凸显了PDCA在规范护理实践及促进更好临床结局方面的效用。进一步研究应探索其在不同临床环境中的更广泛应用。
