Introduction
Stroke is one of the most prevalent neurological diseases among the elderly population, with significant global and regional prevalence data underscoring its public health impact. Globally, the incidence rate of stroke in adults aged 65 and older ranges from 10 to 12 cases per 1,000 population annually, accounting for approximately 72% of all first-ever strokes. This condition severely impacts quality of life and self-care abilities due to its widespread occurrence, high incidence rate, and serious consequences. Stroke, primarily caused by the sudden rupture or occlusion of cerebral blood vessels, leads to acute cerebrovascular events and brain tissue damage. Its characteristics include sudden onset and rapid progression, with acute episodes frequently resulting in neurological deficits. Common clinical symptoms include dizziness, nausea, vomiting, and other manifestations. Post-stroke patients often experience lasting neurological impairments, affecting their quality of life and social functioning [ 1 – 3 ].
The recovery process after stroke is complex and multifaceted, involving the interplay of various physiological and psychological factors. Emerging evidence highlights the critical roles of both rehabilitation and nutritional status in optimizing recovery outcomes. Rehabilitation nursing, through targeted training and functional exercises, aims to restore lost motor and cognitive functions, enhance self-care abilities, and promote functional independence [ 1 , 4 ]. However, the effectiveness of rehabilitation can be significantly compromised by malnutrition, a common comorbidity in stroke patients [ 5 ].
Nutritional status directly relates to patients’ physical health and recovery outcomes. Stroke patients often experience difficulties with swallowing, eating disorders, and are prone to malnutrition, weight loss, and decreased immune function, impacting the disease’s recovery process and prognosis [ 5 , 6 ]. Malnutrition can exacerbate muscle wasting, impair wound healing, weaken the immune system, and reduce functional capacity, all of which hinder the progress of rehabilitation and limit the potential for functional recovery [ 5 ]. Conversely, adequate nutrition provides the necessary building blocks for tissue repair, supports immune function, and enhances energy reserves, creating a more favorable physiological environment for rehabilitation efforts to succeed [ 5 , 6 ].
Therefore, a growing body of research advocates for an integrated approach combining rehabilitation nursing with nutritional intervention [ 7 ]. This combined approach is theoretically grounded in the understanding that rehabilitation and nutrition are not isolated interventions but are synergistically interconnected. Rehabilitation exercises increase energy expenditure and protein needs, making optimal nutritional status even more crucial to meet these increased demands and support tissue repair [ 5 , 6 ]. Conversely, improved nutritional status enhances patients’ physical strength, endurance, and overall well-being, enabling them to participate more effectively in rehabilitation programs and achieve better functional outcomes [ 1 , 4 , 7 ].
Objects and methods
Study population
This study selected elderly stroke patients treated at our hospital from 2021 to 2023 as the study population. Among the initial screening of 320 patients, 20 were excluded due to not meeting the inclusion criteria (such as unclear diagnosis of stroke, changes in consciousness, etc.), and ultimately 300 patients were included. To ensure randomization and minimize selection bias, a detailed randomization procedure was implemented as follows:
Random sequence generation
A random number table was generated using statistical software (SPSS 26.0). Specifically, the RAND function was used to generate a sequence of 300 random numbers, each ranging from 0 to 1.
These random numbers were then sorted in ascending order.
Patients were assigned a sequential number (1 to 300) based on the order of enrollment.
The first 150 patients, corresponding to the lowest 150 random numbers, were assigned to the experimental group. The remaining 150 patients, corresponding to the highest 150 random numbers, were assigned to the control group.
Allocation concealment
To ensure allocation concealment, the random number table and group assignment were generated and stored by an independent researcher who was not directly involved in patient recruitment or intervention.
Upon patient enrollment and eligibility confirmation, the recruiting researcher contacted the independent researcher to obtain the group assignment for each patient.
This process prevented the recruiting researcher from knowing the group assignment in advance and minimized selection bias.
The experimental group received combined rehabilitation nursing and nutritional intervention, while the control group received routine care. This study protocol was approved by the ethics committee of Zibo Central Hospital (No.Z159321). Informed consent was obtained from all study participants. All the methods were carried out in accordance with the Declaration of Helsinki.
Inclusion and exclusion criteria
Inclusion criteria
Patients who met the clinical diagnostic criteria for stroke, confirmed by head imaging examinations (CT or MRI), and were enrolled within 2 weeks to 6 months post-stroke onset. Age ranged from 60 to 90 years, with no gender restrictions. Complete clinical data recording and stable vital signs.
Exclusion criteria
Individuals with disputed or unclear diagnoses of stroke. Presence of altered consciousness, cognitive impairment, communication difficulties, or a family history of psychiatric disorders. Severe dysfunction of important organs such as the heart, lungs, liver, or kidneys. Allergic reactions or contraindications to the treatment methods or medications used in the study.
Methods
Control group
Received Standard Care: The control group received comprehensive standard care, which included the following key components:
Vital Signs Monitoring: Close monitoring of patients’ vital signs, including temperature, respiration, and blood pressure status. Monitoring was conducted continuously or at regular intervals depending on the patient’s condition to ensure stability.
Respiratory Management: Maintenance of open airways through regular suctioning to keep respiratory passages clear and reduce infection risks. Airway clearance was performed every 1–2 h, or as needed based on secretions, using suctioning techniques when necessary.
Positioning and Pressure Ulcer Prevention: Regular repositioning of patients every 2 h to prevent pressure ulcers. Comfortable positions were maintained to prevent joint stiffness and muscle contractures. This included turning patients from side to back, and using pressure-relieving devices as needed.
Muscle Activity and Passive Range of Motion: Passive range-of-motion exercises were performed daily to maintain muscle activity, prevent muscle adhesions, and joint contractures. The frequency and duration of exercises were tailored to the patient’s tolerance and medical condition, typically ranging from several minutes to tens of minutes per session, multiple times daily. These exercises were conducted by professional nurses or rehabilitation therapists.
Nutritional Support: While not receiving specialized nutritional interventions like the experimental group, the control group received routine dietary support to ensure adequate nutritional intake. Meals were provided three times daily, with additional snacks as needed, based on individual patient’s appetite and digestive capacity. Dietary needs were assessed by nursing staff, and diets were adjusted as necessary.
Complication Prevention: Measures were taken to prevent complications such as deep vein thrombosis and pulmonary infections. This included the use of anti-embolism stockings, regular limb massage, and encouraging deep breathing exercises. The specific preventive measures were determined based on the patient’s risk factors and overall condition.
The standard care was provided by professional nurses and nursing staff with extensive clinical experience. Nursing care was delivered under the supervision and evaluation of senior nurses or nursing supervisors to ensure adherence to protocols and to allow for timely adjustments to the care plan based on the patient’s evolving condition. Regular communication and collaboration with physicians, rehabilitation therapists, and other members of the healthcare team were maintained to ensure coordinated and patient-centered care [ 8 , 9 ].
Experimental group
Received Rehabilitation Nursing Combined with Nutritional Intervention: Provided comprehensive pre-meal nutrition guidance, scientifically adjusted dietary structure, and Administer 500 milliliters of nutritional serum daily (twice in the morning and evening), including meat broth, milk, animal liver, vegetable juice, fruit juice, carrots, egg whites, and fish, freshly prepared to ensure nutritional integrity. This nutritional serum provides approximately 400 calories and 20 g of protein per day, and is personalized according to the patient’s weight, nutritional status, and metabolic needs to meet their nutritional needs. To ensure precise energy and protein delivery, individualized targets were calculated based on patient characteristics: Energy intake was set at 25–30 kcal/kg/day, with adjustments for BMI (e.g., 30–35 kcal/kg/day for BMI < 18.5 kg/m², 20–25 kcal/kg/day for BMI ≥ 28 kg/m²). Protein intake was targeted at 1.2–1.5 g/kg/day, with higher protein allocation (1.5–1.8 g/kg/day) for patients with BMI < 18.5 kg/m² or serum albumin < 35 g/L. For example, a patient weighing 60 kg with BMI 22 kg/m² would receive 1500–1800 kcal/day and 72–90 g protein/day, while a patient weighing 50 kg with BMI 18 kg/m² would receive 1500–1750 kcal/day and 75–90 g protein/day. Nutritional status assessments were conducted monthly using a combination of biochemical markers (serum albumin, prealbumin, total lymphocyte count) and anthropometric measurements (body weight, BMI, triceps skinfold thickness). Nutritional improvement plans were dynamically adjusted based on assessment results.
Rehabilitation nursing began approximately 2 days after the patient regained consciousness, stabilized vital signs (defined as systolic blood pressure < 140 mmHg, heart rate 60–100 bpm, respiratory rate 12–20 breaths/min), and demonstrated 48 h without disease flare-ups (as confirmed by neurological exams and imaging), and adjust the specific time according to the patient’s clinical condition and the doctor’s assessment. The rehabilitation protocol was structured in a staged manner with clear progression criteria:
Stage 1 (Passive Range of Motion): For patients unable to move voluntarily (e.g., coma, hemiplegia with Brunnstrom Stage I–II), caregivers or family members assisted with passive exercises twice daily (15–20 min/session) until the patient achieved voluntary movement (Brunnstrom Stage III or higher). Progression to Stage 2 occurred when the patient demonstrated consistent voluntary movement in at least two affected limb segments (e.g., shoulder and elbow flexion) and had a modified Ashworth scale score ≤ 2.
Stage 2 (Active-Assisted Exercises): Systematic functional training followed, ensuring correct limb placement, massage, passive exercises, then progressing to side-to-side turning and upper/lower limb control training until symptoms stabilized (modified Rankin Scale score ≤ 3). Progression to Stage 3 was based on achieving independent active movement in ≥ 50% of planned exercises and a Functional Independence Measure (FIM) score ≥ 18 for mobility.
Stage 3 (Active Strengthening and Balance Training): Patients were encouraged to engage in moderate activity in bed (e.g., isometric exercises, active-assisted range-of-motion motions), avoiding overexertion (defined as Borg Scale rating > 5/10) to prevent worsening conditions. Discharge readiness was assessed when patients could independently transfer, maintain sitting balance for ≥ 30 min, and achieve a Berg Balance Scale score ≥ 40.
After discharge, patients needed to adhere to correct rehabilitation care and training, with caregivers reinforcing psychological and knowledge education for patients and families, emphasizing the importance of rehabilitation care and teaching proper home rehabilitation methods, including balance, coordination, speed training, outdoor activities, and daily life movement training [ 10 , 11 ]. Additionally, due to the diverse conditions of stroke patients (e.g., partial limb paralysis, delayed responses), psychological issues such as low self-esteem, depression, and anxiety were common, affecting rehabilitation effectiveness. Caregivers maintained a strong sense of responsibility, built trust through empathetic communication, provided meticulous care for depressed patients, actively guided emotional expression, and fostered optimism to promote psychological recovery. The intervention lasts for 8 weeks, with 5 rehabilitation training sessions and nutritional interventions per week. During the intervention process, we evaluated patients’ compliance with the intervention plan through regular follow-up and recording, and found that most patients were able to receive treatment according to the requirements of the plan. At the same time, we closely monitored potential side effects in patients, such as indigestion and allergic reactions, and recorded the incidence of related events. The results showed that the patients had good compliance with the intervention plan and no serious side effects occurred. All evaluations are conducted by trained medical staff who are not familiar with patient grouping to ensure objectivity and accuracy of the evaluations. The sample size calculation is based on expected effect size, available resources, and research design, with a total of 300 patients included, with 150 patients in each group, to ensure sufficient statistical power.
Observation indicators
Clinical efficacy
Neurological Deficit Scale (NDS) and Mini-Mental State Examination (MMSE) were used to evaluate treatment effectiveness. Higher NDS scores indicate more severe neurological deficits, while MMSE scores between 27 and 30 indicate normal cognitive function, 21–27 indicate mild cognitive impairment, 10–20 indicate moderate cognitive impairment, and 9 or below indicate severe cognitive impairment.
Activities of daily living (ADL)
Barthel Index was used to assess patients’ ability to perform daily activities such as eating, transferring, grooming, etc. The total score ranges from 0 to 100 points, with individual item scores ranging from 0 to 5, 10, or 15 points depending on the specific activity. For example, ‘feeding’ is scored from 0 (unable) to 5 points (independent), while ‘bathing’ is scored from 0 (dependent) to 5 points (independent). The higher the score, the better the patient’s ability to take care of themselves in daily life. A score of 0 indicates complete dependence in all activities, while a score of 100 indicates complete independence in all activities..
Nutritional status
Fasting venous blood samples of 5 ml were collected from both groups, and after centrifugation, serum was obtained. Serum levels of albumin (ALB), prealbumin (PAB), triglycerides (TG), and total cholesterol (TC) were measured using a fully automated biochemical analyzer at 3000r for 15 min. The normal range of ALB is 35–55 g/L. The physiological range of ALB in healthy adults is approximately 35–55 g/L, with values below 30 g/L indicating severe malnutrition and values above 60 g/L being rarely observed in clinical practice. Exceeding 55 g/L may indicate dehydration or blood concentration, and may also be related to certain disease states, such as multiple myeloma; A significant increase in ALB above 55 g/L may suggest hemoconcentration due to dehydration or an underlying pathological condition requiring further investigation. Below 35 g/L may indicate malnutrition, liver disease (such as cirrhosis, hepatitis), or excessive protein loss (such as nephrotic syndrome). A decrease in ALB below 30 g/L is particularly concerning as it can lead to edema, impaired wound healing, and increased susceptibility to infections. The normal range of PAB is 240-350 mg/L. The physiological range of PAB is 240-350 mg/L, with values below 200 mg/L considered indicative of significant malnutrition and values above 400 mg/L being less common and potentially reflecting acute phase reactions. Exceeding 350 mg/L may indicate blood concentration or enhanced liver metabolism, or may be related to certain acute phase reactions; A marked elevation of PAB above 400 mg/L might be observed in acute inflammatory conditions or liver regeneration. Below 240 mg/L is a sensitive indicator of malnutrition and may also be associated with chronic infections, liver and gallbladder diseases, or malignant tumors. A PAB level consistently below 200 mg/L strongly suggests ongoing protein-energy malnutrition and requires nutritional intervention. The normal value range of TG is 0.45-1.70mmol/L, and more than 1.70mmol/L may increase the risk of cardiovascular disease, which is related to atherosclerosis, diabetes, obesity, etc.; Severe hypertriglyceridemia (TG > 5.6mmol/L) significantly increases the risk of acute pancreatitis. Below 0.45mmol/L may indicate malnutrition, malabsorption, or certain genetic diseases. Very low TG levels (< 0.45mmol/L) can be associated with malabsorption syndromes or genetic disorders affecting lipid metabolism. TC normal value range: 2.9-6.0mmol/L, more than 6.0mmol/L is associated with increased risk of atherosclerosis and cardiovascular disease; TC levels above 7.8mmol/L are classified as severely elevated and warrant aggressive lipid-lowering therapy. Below 2.9 mmol/L may indicate malnutrition, liver disease (such as cirrhosis), or certain genetic disorders. TC levels below 2.9mmol/L may be seen in severe malnutrition, chronic liver disease, or hyperthyroidism. In addition to these biochemical parameters, the following comprehensive nutritional assessments were conducted. Dietary Intake Assessment: A 3-day dietary recall was performed to evaluate the average daily intake of protein. 0.8–1.2 g per kilogram of body weight per day, for example, an adult weighing 50 kg needs to consume 40–60 g per day. A protein intake below 0.6 g/kg/day is considered insufficient for most adults and can lead to negative nitrogen balance and muscle wasting over time. Insufficient intake may lead to malnutrition, weight loss, and weakened immunity; Chronic protein intake below 0.6 g/kg/day significantly increases the risk of sarcopenia and impaired immune function. Excessive intake may lead to an increased risk of obesity, metabolic syndrome, and chronic diseases. Protein intake exceeding 2.0 g/kg/day for extended periods may strain renal function, particularly in individuals with pre-existing kidney disease. Mid Upper Arm Circus (MUAC): Measure with a soft tape at the midpoint of the biceps brachii muscle in the upper arm, ensuring that the measuring tape is tightly attached to the skin but not compressed. MUAC was measured to evaluate muscle mass and subcutaneous tissue. Normal MUAC ranges vary by gender and age, with typical adult ranges being 25–35 cm for males and 20–25 cm for females. MUAC values below 23 cm in males or 19 cm in females are generally indicative of malnutrition. A decrease may indicate malnutrition or muscle loss; A decrease in MUAC of more than 1 cm over a short period (e.g., 1 month) suggests significant muscle wasting and requires urgent nutritional assessment. An increase may indicate overnutrition or edema. A rapid increase in MUAC, particularly in the context of fluid retention or edema, may not reflect true muscle gain and requires careful clinical interpretation. Grip Strength: Use a grip strength meter to measure the natural sagging of the upper limbs 2–3 times and take the maximum value. Grip strength index = Grip strength (kg)/Body weight (kg) × 100%, normal grip strength index ≥ 50%. Grip strength values vary by gender and age. For example, in healthy adults aged 60–69, normal grip strength is approximately 25–35 kg for males and 15–25 kg for females. Decreased grip strength may indicate muscle weakness, neuromuscular disorders, or systemic diseases; A grip strength decline of more than 10% from baseline may indicate functional decline or the onset of a systemic illness. Enhanced grip strength may indicate improved muscle strength or rehabilitation effects. A significant increase in grip strength, particularly after a targeted exercise program, suggests positive adaptation and functional improvement. These additional assessments provide a more comprehensive evaluation of nutritional status.
Motor function
The abbreviated Fugl-Meyer Assessment (FMA) was used to evaluate patients’ motor function. The FMA is a performance-based impairment index designed to assess motor functioning, balance, sensation and joint functioning in patients with post-stroke hemiparesis. The total score ranges from 0 to 100 points, with individual section scores ranging from 0 to 2, 3, or 14 points depending on the specific assessment section (e.g., balance function assessment has a maximum score of 14 points). The higher the score, the better the patient’s motor function. A score of 0 indicates no voluntary movement in the affected limb, while a score of 100 indicates normal motor function in all assessed domains.
Data analysis
Data organization and statistical analysis were conducted using SPSS 26.0 software. Continuous variables are expressed as mean ± standard deviation (SD). For inter group comparison (experimental group vs. control group): If the data conforms to the normality hypothesis (Kolmogorov Smirnov test P > 0.05) and homogeneity of variance (Levene’s test P > 0.05), independent sample t-test is used. If the normality assumption is violated, use Mann Whitney U test for non parametric analysis. For intra group comparison (before and after intervention): If the paired differences conform to the normality hypothesis, paired sample t-test will be used. If normality is violated, Wilcoxon signed rank test is used for non parametric analysis. Categorical variables are expressed as percentages (%) and analyzed using chi square (chi square) test. All statistical tests are two-sided tests, with a significance level set at P < 0.05.
Results
Basic information
The experimental group comprised 150 patients, including 81 males and 69 females, with ages ranging from 60 to 80 years (mean age of 65.24 ± 7.11 years) and education durations ranging from 3 to 18 years (mean duration of 10.03 ± 2.88 years), Marital status: 59 cases are married, 5 cases are unmarried, 33 cases are divorced, and 53 cases are widowed. The control group comprised 150 patients, including 78 males and 72 females, with ages ranging from 60 to 80 years (mean age of 64.99 ± 7.36 years) and education durations ranging from 3 to 18 years (mean duration of 10.24 ± 2.97 years), Marital status: 62 cases are married, 3 cases are unmarried, 34 cases are divorced, and 51 cases are widowed. There were no significant differences in basic information between the two groups, indicating comparability ( P > 0.05). See Table 1 .
Table 1 Comparison of basic information between two groups of patients Experimental group Control group t P Number of examples - 150 150 - - Gender Male 81 78 - - Female 69 72 - - Age - 60–80 60–80 - - Average 65.24 ± 7.11 64.99 ± 7.36 0.299 0.765 Years of Education - 3–18 3–18 - - Average 10.03 ± 2.88 10.24 ± 2.97 0.652 0.535 Marital status Married 59 62 - - Unmarried 5 3 - - Divorced 33 34 - - Widowed 53 51 - -
Table 1
Comparison of basic information between two groups of patients
| Experimental group | Control group | t | P | ||
| Number of examples | - | 150 | 150 | - | - |
| Gender | Male | 81 | 78 | - | - |
| Female | 69 | 72 | - | - | |
| Age | - | 60–80 | 60–80 | - | - |
| Average | 65.24 ± 7.11 | 64.99 ± 7.36 | 0.299 | 0.765 | |
| Years of Education | - | 3–18 | 3–18 | - | - |
| Average | 10.03 ± 2.88 | 10.24 ± 2.97 | 0.652 | 0.535 | |
| Marital status | Married | 59 | 62 | - | - |
| Unmarried | 5 | 3 | - | - | |
| Divorced | 33 | 34 | - | - | |
| Widowed | 53 | 51 | - | - |
Clinical efficacy
There were no significant differences in NDS and MMSE scores between the two groups of patients before treatment ( P > 0.05). After treatment, the NDS score in the experimental group was significantly lower than that in the control group, while the MMSE score was higher than that in the control group, with P < 0.05. See Fig. 1 .
Fig. 1 Comparison of NDS and MMSE scores between the two groups before and after intervention Note: * indicates a significant difference between the two groups, with t = 21.105, t = 17.145, P < 0.05
Self-care ability
There were no significant differences in self-care ability between the two groups of patients before treatment ( P > 0.05). After treatment, the Barthel index in the experimental group was higher than that in the control group, with P < 0.05. See Fig. 2 .
Fig. 2 Comparison of Barthel index scores between the two groups before and after intervention Note: * indicates a significant difference between the two groups, with t = 5.948, P < 0.05
Nutritional status
After treatment, the levels of ALB, PAB in the experimental group(36.56 ± 2.99, 261.32 ± 42.65), were higher than those in the control group(30.88 ± 3.14, 233.54 ± 38.65), protein intake, MUAC, and grip strength(1.35 ± 0.28, 26.25 ± 2.13, 23.11 ± 4.15) were significantly higher than those in the control group(0.81 ± 0.12, 23.85 ± 1.48, 18.12 ± 3.45), TG and TC were all Lower in the experimental group(1.65 ± 0.41, 4.43 ± 0.47) than the control group(1.94 ± 0.22, 4.94 ± 0.51), with P < 0.05. See Fig. 3 .
Fig. 3 Comparison of nutritional indicator levels between the two groups after intervention Note: * indicates a significant difference between the two groups, with t = 16.044, t = 5.911, t = 7.633, t = 9.006, t = 21.710, t = 11.333, t = 11.324, P < 0.05
Motor function
After treatment, the FMA scores in the experimental group were higher than those in the control group, with P < 0.05. See Fig. 4 .
Fig. 4 Comparison of FMA scores between the two groups after intervention Note: * indicates a significant difference between the two groups, with t = 16.762, P < 0.05
Discussion
Stroke, as a high-incidence disease among the middle-aged and elderly population, shows a significant upward trend in incidence with age. According to statistics, the incidence rate of stroke among the elderly aged 60 and above in China has reached 120–180 per 100,000 people annually, and for every 5-year increase in age, the incidence of ischemic stroke can rise by 100%. The Global Burden of Disease Study reveals that stroke ranks as one of the three leading causes of death worldwide, responsible for approximately 6.6 million deaths annually, accounting for 32.3% of all cardiovascular disease-related deaths. This disease is characterized not only by its high fatality rate but also by a high disability rate. Currently, there are about 13 million stroke survivors in China, with 75-85% of them experiencing residual limb dysfunction, and approximately three-quarters of survivors losing their ability to work and requiring long-term care and support [ 12 , 13 ]. From 1990 to 2021, the incidence rate of stroke in China increased by 143%, and the number of patients increased by 145%. In 2019, the incidence of stroke among residents aged 40 and above in China was approximately 2.58%, with an estimated 17.5 million affected individuals. The Chinese Stroke Prevention and Control Report (2023) states that the current number of stroke patients aged 40 and above in China has reached 12.42 million. According to other data, the total number of stroke patients in China exceeds 28 million, with over 17 million stroke patients surviving with the disease. Despite the significant improvement in stroke treatment success rates with modern medical technology, many patients still face varying degrees of cognitive impairment, motor dysfunction, language impairment, and other issues after treatment, leading to a decline in self-care ability and significantly impacting post-discharge quality of life. Therefore, rehabilitation exercises have become a crucial step in improving post-discharge self-care abilities and enhancing quality of life for stroke patients [ 14 , 15 ]. However, in traditional home care models, due to the lack of professional knowledge and skills among patients and their families, the actual rehabilitation effects often differ significantly from the expected outcomes.
This study aims to explore the effect of rehabilitation nursing combined with nutritional intervention on the self-care ability and nutritional status of elderly stroke patients. First, patients were assessed using the Neurological Deficit Scale (NDS) and Mini-Mental State Examination (MMSE). The results showed a significant decrease in NDS scores, indicating an alleviation of neurological deficits in patients. Meanwhile, MMSE scores showed an upward trend after intervention, indicating a recovery in cognitive function. This suggests that combining rehabilitation nursing with nutritional intervention has a positive impact on improving the neurological function and cognitive status of stroke patients. Furthermore, the self-care ability of patients was evaluated using the Barthel Index, which revealed a significant increase in scores post-intervention. This indicates an improvement in patients’ independent abilities in daily activities such as eating, transferring, and grooming. Additionally, the results from the Fugl-Meyer Assessment (FMA) showed a significant improvement in motor function scores after combining rehabilitation nursing with nutritional intervention. This suggests a significant effect on improving motor function in stroke patients, highlighting the notable impact of this combined approach on enhancing patients’ self-care abilities. Rehabilitation nursing training is a specialized medical care method designed to assist patients in addressing various health issues, including diseases, injuries, surgeries, disabilities, etc., to restore their function and improve their quality of life. This training covers multiple aspects, including physical movement, language abilities, and cognitive functions. Through a structured rehabilitation plan, patients can gradually improve their quality of life and regain their self-care abilities [ 16 , 17 ]. Previous studies have found that rehabilitation nursing training in elderly stroke patients has a significantly positive impact on rehabilitation outcomes, helping reduce the incidence of complications. Therefore, incorporating rehabilitation nursing training into the treatment plan for stroke patients is of great importance and aligns with the results of this study. Additionally, research has shown that the first three months after a stroke are critical for rehabilitation, and malnutrition is one of the main reasons affecting rehabilitation outcomes. Nutrition plays a crucial role in treating diseases and stabilizing conditions. In rehabilitation treatment, nutrition management is essential, involving aspects such as neurofunctional recovery, infection prevention and control, and immune function regulation, which can help improve rehabilitation outcomes and shorten hospital stays [ 18 , 19 ]. However, to achieve the desired outcomes, a detailed understanding of each patient’s nutritional status, metabolic functions, and the methods and effects of nutritional interventions is necessary. This study also assessed patients’ nutritional status, revealing improvements in nutrition levels post-rehabilitation nursing combined with nutritional intervention. Serum albumin (ALB) and prealbumin (PAB) levels significantly increased, while triglycerides (TG) and total cholesterol (TC) levels decreased, and protein intake, MUAC, and grip strength levels significantly increased, indicating optimized nutritional status. This demonstrates that combining rehabilitation nursing with nutritional intervention plays a positive role in improving the nutritional status of stroke patients [ 20 , 21 ]. In recent years, with the continuous development of medical science and technology, there has been a higher demand for nutritional support in clinical settings. It is no longer limited to simply providing nutrition and maintaining nitrogen balance but also emphasizes the role of nutrition support in regulating physiological functions, promoting tissue recovery, and enhancing immune functions. Given that elderly stroke patients often spend prolonged periods in bed, and caregivers lack scientific feeding knowledge, patients’ nutritional status can easily decline, affecting their recovery of rehabilitation treatment and life skills. Therefore, this study incorporated nutritional therapy based on rehabilitation nursing, providing scientific nutrition guidance to patients and their families and offering nutrition supplements with balanced ratios. Ensuring sufficient energy intake based on patients’ rehabilitation needs is beneficial for maintaining intestinal mucosal barrier integrity, balancing gut flora, and enhancing the body’s absorption and utilization of nutrients. This helps accelerate the recovery of intestinal self-defense functions, strengthen the body’s immunity, and resistance capabilities [ 22 , 23 ].
Based on the above results, the combination of rehabilitation nursing and nutritional intervention has a significant promoting effect on the self-care ability, neurological function, cognitive status, and nutritional status of elderly stroke patients. Therefore, in clinical practice, we should pay attention to the combined application of rehabilitation nursing and nutritional intervention to improve the rehabilitation outcomes and quality of life of stroke patients.
In summary, the combination of rehabilitation nursing and nutritional intervention demonstrates a significant improvement effect on the self-care ability and nutritional status of elderly stroke patients. This comprehensive intervention measure holds important value for promotion in clinical practice, as it contributes to enhancing rehabilitation outcomes and the quality of life for stroke patients.
We acknowledge several limitations to our study. Firstly, while our sample size was adequate to demonstrate statistically significant improvements, it may not fully represent the diverse elderly stroke population. Our inclusion and exclusion criteria, while necessary to ensure patient safety and study feasibility, may have introduced selection bias. Specifically, we excluded patients with severe cognitive impairment and communication difficulties, which are common in elderly stroke populations. This exclusion may limit the generalizability of our findings to the most severely affected patients. Furthermore, our study population was recruited from a single center, which may not reflect the full spectrum of elderly stroke patients seen in diverse clinical settings. Secondly, we observed varying degrees of improvement across different outcome measures. While self-care abilities, as measured by the Barthel Index, and nutritional status showed significant improvements, the improvements in motor function, as measured by the Fugl-Meyer Assessment, were relatively modest. Several factors may contribute to this variation. The intervention’s focus on rehabilitation nursing and nutritional support may have a more direct and immediate impact on self-care and nutritional status compared to motor function recovery, which is often a slower and more complex process. Additionally, individual patient factors, such as stroke severity, pre-existing comorbidities, and baseline functional status, likely influenced the degree of improvement across different domains. Future studies should explore the factors influencing differential response to intervention and consider tailored interventions targeting specific functional deficits. Thirdly, the study period, while sufficient to observe immediate improvements, may not capture the long-term sustainability of these effects. Finally, the study was conducted within a specific geographical and cultural context, which may limit the generalizability of the findings to other populations.
Our findings have several important clinical implications for healthcare providers working with elderly stroke patients:
Implement Integrated Care Pathways: Healthcare providers should move beyond isolated interventions and adopt integrated care pathways that combine rehabilitation nursing with targeted nutritional support. This approach recognizes the interconnectedness of physical function, nutritional status, and overall recovery in stroke patients. Staged Rehabilitation with Clear Progression Criteria: Develop and implement staged rehabilitation protocols with explicit, measurable progression criteria, as outlined in our study. This structured approach ensures rehabilitation is tailored to the patient’s evolving capabilities and maximizes functional gains. Advocate for Multi-Disciplinary Team Care: Promote and facilitate multi-disciplinary team care models, bringing together physicians, nurses, rehabilitation therapists, dietitians, and social workers to provide holistic, patient-centered care. Future research with larger, more diverse samples, extended follow-up periods, and multi-center collaborations are warranted to validate and expand upon these promising results. Additionally, exploring the cost-effectiveness and patient adherence to such comprehensive interventions would further enhance their clinical applicability.
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Acknowledgements
Not applicable.
Author contributions
Liu Mei, Xing Li designed the research study. Gaoxiao Chen performed the research. Zhangjian Fang conducted experiments, analyzed the data. All authors contributed to editorial changes in the manuscript. All authors read and approved the final manuscript.
Funding
Not applicable.
Data availability
No datasets were generated or analysed during the current study.
Declarations
Ethics approval and consent to participate
This study was approved by the ethics committee of Zibo Central Hospital (No.Z159321). Informed consent was obtained from all study participants. All the methods were carried out in accordance with the Declaration of Helsinki.
Consent for publication
Not applicable.
Competing interests
The authors declare no competing interests.
References
1. Hara Y Brain plasticity and rehabilitation in stroke patients J Nippon Med Sch 2015 82 1 4 13 10.1272/jnms.82.4 25797869 Hara Y. Brain plasticity and rehabilitation in stroke patients. J Nippon Med Sch. 2015;82(1):4–13. 25797869 10.1272/jnms.82.4
2. Pare JR Kahn JH Basic neuroanatomy and stroke syndromes Emerg Med Clin North Am 2012 30 3 601 15 10.1016/j.emc.2012.05.004 22974640 Pare JR, Kahn JH. Basic neuroanatomy and stroke syndromes. Emerg Med Clin North Am. 2012;30(3):601–15. 22974640 10.1016/j.emc.2012.05.004
3. Geranmayeh F Cholinergic neurotransmitter system: a potential marker for post-stroke cognitive recovery Brain 2022 145 5 1576 8 10.1093/brain/awac142 35438715 PMC9166539 Geranmayeh F. Cholinergic neurotransmitter system: a potential marker for post-stroke cognitive recovery. Brain. 2022;145(5):1576–8. 35438715 10.1093/brain/awac142 PMC9166539
4. Ward NS Functional reorganization of the cerebral motor system after stroke Curr Opin Neurol 2004 17 6 725 30 10.1097/00019052-200412000-00013 15542982 Ward NS. Functional reorganization of the cerebral motor system after stroke. Curr Opin Neurol. 2004;17(6):725–30. 15542982 10.1097/00019052-200412000-00013
5. Rabadi MH Intensive nutritional supplements can improve outcomes in stroke rehabilitation Neurology 2008 71 23 1856 61 10.1212/01.wnl.0000327092.39422.3c 18946003 Rabadi MH, et al. Intensive nutritional supplements can improve outcomes in stroke rehabilitation. Neurology. 2008;71(23):1856–61. 18946003 10.1212/01.wnl.0000327092.39422.3c
6. Giovannini S The role of nutritional supplement on post-stroke fatigue: a pilot randomized controlled trial J Nutr Health Aging 2024 28 7 100256 10.1016/j.jnha.2024.100256 38696891 Giovannini S, et al. The role of nutritional supplement on post-stroke fatigue: a pilot randomized controlled trial. J Nutr Health Aging. 2024;28(7):100256. 38696891 10.1016/j.jnha.2024.100256
7. Torrisi M The role of rehabilitation and vitamin D supplementation on motor and psychological outcomes in poststroke patients Med (Baltim) 2021 100 45 e27747 10.1097/MD.0000000000027747 PMC8589234 34766589 Torrisi M, et al. The role of rehabilitation and vitamin D supplementation on motor and psychological outcomes in poststroke patients. Med (Baltim). 2021;100(45):e27747. 10.1097/MD.0000000000027747 PMC8589234 34766589
8. Sacco RL An updated definition of stroke for the 21st century: a statement for healthcare professionals from the American heart association/american stroke association Stroke 2013 44 7 2064 89 10.1161/STR.0b013e318296aeca 23652265 PMC11078537 Sacco RL, et al. An updated definition of stroke for the 21st century: a statement for healthcare professionals from the American heart association/american stroke association. Stroke. 2013;44(7):2064–89. 23652265 10.1161/STR.0b013e318296aeca PMC11078537
9. Hemphill JC Guidelines for the management of spontaneous intracerebral hemorrhage: A guideline for healthcare professionals from the American heart association/american stroke association Stroke 2015 46 7 2032 60 10.1161/STR.0000000000000069 26022637 Hemphill JC 3, et al. Guidelines for the management of spontaneous intracerebral hemorrhage: A guideline for healthcare professionals from the American heart association/american stroke association. Stroke. 2015;46(7):2032–60. 26022637 10.1161/STR.0000000000000069
10. Chen J Li S Clinical study of neurology nursing on cerebral apoplexy rehabilitation Transl Neurosci 2019 10 164 7 10.1515/tnsci-2019-0029 31410298 PMC6689212 Chen J, Li S. Clinical study of neurology nursing on cerebral apoplexy rehabilitation. Transl Neurosci. 2019;10:164–7. 31410298 10.1515/tnsci-2019-0029 PMC6689212
11. Fukusako S Maesako Y Rehabilitation nursing of a patient with cerebral apoplexy - a study on promoting self-reliance in daily activities] Hokenfu Zasshi 1975 31 2 109 16 1039430 Fukusako S, Maesako Y. Rehabilitation nursing of a patient with cerebral apoplexy - a study on promoting self-reliance in daily activities]. Hokenfu Zasshi. 1975;31(2):109–16. 1039430
12. Bütefisch CM Plasticity in the human cerebral cortex: lessons from the normal brain and from stroke Neuroscientist 2004 10 2 163 73 10.1177/1073858403262152 15070490 Bütefisch CM. Plasticity in the human cerebral cortex: lessons from the normal brain and from stroke. Neuroscientist. 2004;10(2):163–73. 15070490 10.1177/1073858403262152
13. Puy L Neuroimaging determinants of poststroke cognitive performance Stroke 2018 49 11 2666 73 10.1161/STROKEAHA.118.021981 30355190 Puy L, et al. Neuroimaging determinants of poststroke cognitive performance. Stroke. 2018;49(11):2666–73. 30355190 10.1161/STROKEAHA.118.021981
14. Inoue M Ikeda S [Nursing process: nursing of apoplexy patients. Nursing of an apoplexy patient excessively dependent on her family] Kurinikaru Sutadi 1985 6 2 162 9 3846068 Inoue M, Ikeda S. [Nursing process: nursing of apoplexy patients. Nursing of an apoplexy patient excessively dependent on her family]. Kurinikaru Sutadi. 1985;6(2):162–9. 3846068
15. Yamagishi E Murakami C Nursing of a patient with cerebral apoplexy–from the onset of the disease to rehabilitation stage] Kangogaku Zasshi 1973 37 10 1272 6 4201333 Yamagishi E, Murakami C. Nursing of a patient with cerebral apoplexy–from the onset of the disease to rehabilitation stage]. Kangogaku Zasshi. 1973;37(10):1272–6. 4201333
16. Arlien-Søborg P Sørensen PS Damgaard M Social consequences of cerebral apoplexy. A review of 129 patients with cerebral apoplexy admitted as emergencies to a neuromedical department in Copenhagen in the course of a year] Ugeskr Laeger 1980 142 46 3078 81 7445217 Arlien-Søborg P, Sørensen PS, Damgaard M. Social consequences of cerebral apoplexy. A review of 129 patients with cerebral apoplexy admitted as emergencies to a neuromedical department in Copenhagen in the course of a year]. Ugeskr Laeger. 1980;142(46):3078–81. 7445217
17. Watarai H [An observation on training in overnight stay away from the hospital during the rehabilitation program of patients following cerebral apoplexy] Kango Tenbo 1978 3 11 49 54 251796 Watarai H, et al. [An observation on training in overnight stay away from the hospital during the rehabilitation program of patients following cerebral apoplexy]. Kango Tenbo. 1978;3(11):49–54. 251796
18. Martin SS 2024 heart disease and stroke statistics: A report of US and global data from the American heart association Circulation 2024 149 8 e347 913 10.1161/CIR.0000000000001209 38264914 PMC12146881 Martin SS, et al. 2024 heart disease and stroke statistics: A report of US and global data from the American heart association. Circulation. 2024;149(8):e347–913. 38264914 10.1161/CIR.0000000000001209 PMC12146881
19. Zielińska-Nowak E et al. Nutritional supplements and neuroprotective diets and their potential clinical significance in Post-Stroke rehabilitation. Nutrients, 2021. 13(8). 10.3390/nu13082704 PMC8399756 34444864
20. Mellendijk L Wiesmann M Kiliaan AJ Impact of nutrition on cerebral circulation and cognition in the metabolic syndrome Nutrients 2015 7 11 9416 39 10.3390/nu7115477 26580647 PMC4663605 Mellendijk L, Wiesmann M, Kiliaan AJ. Impact of nutrition on cerebral circulation and cognition in the metabolic syndrome. Nutrients. 2015;7(11):9416–39. 26580647 10.3390/nu7115477 PMC4663605
21. Marin S et al. Economic evaluation of clinical, nutritional and rehabilitation interventions on oropharyngeal dysphagia after stroke: A systematic review. Nutrients, 2023. 15(7). 10.3390/nu15071714 PMC10097035 37049553
22. Wang J Chang E Jiang Y Effects of vitamin C stimulation on rehabilitation of dysphagia after stroke: a randomized trial Eur J Phys Rehabil Med 2022 58 4 558 64 10.23736/S1973-9087.22.07337-3 35362717 PMC9980537 Wang J, Chang E, Jiang Y. Effects of vitamin C stimulation on rehabilitation of dysphagia after stroke: a randomized trial. Eur J Phys Rehabil Med. 2022;58(4):558–64. 35362717 10.23736/S1973-9087.22.07337-3 PMC9980537
23. Gao Z Chen H Advances in the beneficial effects of nutrition on stroke-related sarcopenia: A narrative review Med (Baltim) 2023 102 24 e34048 10.1097/MD.0000000000034048 PMC10270533 37327307 Gao Z, Chen H. Advances in the beneficial effects of nutrition on stroke-related sarcopenia: A narrative review. Med (Baltim). 2023;102(24):e34048. 10.1097/MD.0000000000034048 PMC10270533 37327307