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. 2025 Jun 6:16:1554384.
doi: 10.3389/fneur.2025.1554384. eCollection 2025.

Effect of PDCA-optimized good limb positioning on hemiparetic rehabilitation outcomes in acute cerebral infarction

Wei Liu  1 , Guangyan Yao  1 , Zhihui Song  1 , Xin He  1
Affiliations

Effect of PDCA-optimized good limb positioning on hemiparetic rehabilitation outcomes in acute cerebral infarction

Wei Liu et al. Front Neurol. .

Abstract

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.

Keywords: PDCA cycle; acute cerebral infarction; early rehabilitation; functional recovery; good limb positioning.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Five early rehabilitation positions for good limb positioning in hemiplegic patients, including side-lying, supine, bed sitting, and wheelchair sitting (a–e). Yellow represents the hemiplegic side, while purple indicates the non-hemiplegic side.
Figure 2
Figure 2
Fishbone analysis of reasons for low good limb positioning rate in ACI hemiplegic patients. Red highlights indicate the four primary causes.
Figure 3
Figure 3
Histograms of Intervention Outcomes and Prognostic Data Normality Assessment. The normality of prognostic data was assessed using the Kolmogorov–Smirnov (K-S) test, with histograms illustrating the distribution. Quality of life and activities of daily living data demonstrated good normality (p > 0.05).
Figure 4
Figure 4
Prognostic visualization. (a,b) Violin plots with Mann–Whitney U test. (c) Box plots with Chi-square test.
See this image and copyright information in PMC

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References

    1. Chen LL, Wang WT, Zhang S, Liu HM, Yuan XY, Yang X, et al. Cohort study on the prognosis of acute cerebral infarction in different circulatory systems at 1-year follow-up. BMC Cardiovasc Disord. (2021) 21:521. doi: 10.1186/s12872-021-02291-0, PMID: - DOI - PMC - PubMed
    1. Chen QQ, Lin FM, Chen DH, Ye YM, Gong GM, Chen FF, et al. Analysis of mental health status and related factors in patients with acute cerebral infarction. World J Psychiatry. (2023) 13:793–802. doi: 10.5498/wjp.v13.i10.793, PMID: - DOI - PMC - PubMed
    1. Anjos JM, Neto MG, de Araújo Tapparelli Y, Tse G, Biondi-Zoccai G, de Souza Lima Bitar Y, et al. Efficacy and safety of very early mobilization after thrombolysis in acute ischemic stroke: a randomized clinical trial. J Neurol. (2023) 270:843–50. doi: 10.1007/s00415-022-11411-5, PMID: - DOI - PMC - PubMed
    1. Zeng H, Chen J, Guo Y, Tan S. Prevalence and risk factors for spasticity after stroke: a systematic review and meta-analysis. Front Neurol. (2020) 11:616097. doi: 10.3389/fneur.2020.616097, PMID: - DOI - PMC - PubMed
    1. Salazar AP, Pinto C, Ruschel Mossi JV, Figueiro B, Lukrafka JL, Pagnussat AS. Effectiveness of static stretching positioning on post-stroke upper-limb spasticity and mobility: systematic review with meta-analysis. Ann Phys Rehabil Med. (2019) 62:274–82. doi: 10.1016/j.rehab.2018.11.004, PMID: - DOI - PubMed

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