Can practice undertaken by patients be increased simply through implementing agreed national guidelines?' An observational study

Objective: To increase autonomous practice time of patients on the stroke unit of a nursing home. Intervention: Nurses stimulated and coached patients with the help of four interventions (muscle strengthening, sitting balance and reach, getting up from a chair, walking) from the evidence-based Clinical Nursing Rehabilitation Stroke Guidelines. Design: An observational study. Practice time of elderly stroke patients in this study was compared with the time observed in our previous study in the same setting. Setting: Rehabilitation units of a nursing home in the Netherlands. Subjects: Seventeen frail stroke patients, including 8 men, 9 women, with a mean age of 75.8 (SD ± 9) and 17 subjects with the same characteristics who participated in a previous observational study. Main measures: Time spent on therapeutic activities was measured using the Behavioral Mapping method. Results: The time spent on therapeutic activities increased significantly from 103.5 minutes measured in our previous study to 156.5 minutes in this study (Z = 2.86; P < 0.005; d' = 1.09) The mean Barthel Index score was 8.8 (SD ± 4.1). The patients with more possibilities were more active, resulting in a significant positive Barthel Indextherapy time relationship (r = 0.73, P ≤ 0.001). Conclusions: The autonomous practice time of older fragile comorbid stroke patients increased during the weekdays. Patients, stimulated and challenged by nurses, exercise harder and more according to their possibilities. Since this guideline was developed especially for nurses, nurses can stimulate stroke patients to contribute more to autonomous practice and therefore help their recovery. © The Author(s) 2012.