Effects of All-Inclusive and Hierarchical Rehabilitation Nursing Model Combined with Acupuncture on Limb Function and Quality of Life in Elderly Patients with Cerebral Infarction during Convalescence

This study investigated an innovative rehabilitation approach for elderly patients recovering from ischemic stroke, combining traditional Chinese acupuncture with a hierarchical rehabilitation nursing model. Ischemic stroke is one of the leading causes of death and disability in China, especially among the elderly, with approximately 75% of survivors developing some degree of disability and 40% experiencing severe disability. The convalescent period, defined as the first year after stroke, is considered critical for rehabilitation interventions that can improve neurologic function and motor capacity. The study was conducted as a retrospective randomized controlled trial at the Affiliated Hospital of Chifeng University in Inner Mongolia, China, between February 2018 and February 2020.

Eighty elderly patients (60+ years) with cerebral infarction confirmed by magnetic resonance imaging and computed tomography were randomized into two groups of 40 participants each. All patients received conventional neurologic pharmacotherapy and acupuncture using the Xingnao Kaiqiao technique (awakening of consciousness), with needling at Renzhong, Sanyinjiao, Neiguan, Jiquan, Chize, and Weizhong. Sessions lasted 30 minutes after the arrival of qi, performed daily, 6 days per week, for 3 months. The control group received conventional rehabilitation nursing, whereas the observation group received an innovative hierarchical nursing model.

This model organized the nursing team into three tiers: assistant nurses (less than 5 years of experience) responsible for basic care, primary nurses (5–10 years of experience) in charge of routine care, and head nurses and deputy directors (more than 10 years of experience) responsible for health education, psychological care, recovery guidance, and complex nursing operations. The model implemented a continuous 8-hour shift system and tier-specific training. Outcomes were assessed using validated scales: Fugl-Meyer Assessment (FMA) for limb function, Modified Edinburgh-Scandinavian Stroke Scale (MESSS) for neurologic function, Activities of Daily Living Scale (ADL) for functional capacity, and Stroke-Specific Quality of Life Scale (SS-QOL) for quality of life. The results demonstrated significant benefits of the hierarchical model combined with acupuncture.

On the FMA, the observation group showed higher scores for both upper limbs (52.85 ± 4.70 vs 44.68 ± 4.81 points, P < 0.001) and lower limbs (27.00 ± 3.54 vs 21.40 ± 3.27 points, P < 0.001) compared with the control group. Neurologic function improved substantially, with the observation group showing significantly lower MESSS scores (14.28 ± 1.64 vs 18.10 ± 1.62, P < 0.001), indicating less neurologic deficit. Activities of daily living showed marked improvement in the observation group (68.88 ± 8.91 vs 59.00 ± 8.38 points, P < 0.001). All quality-of-life domains assessed by the SS-QOL showed significant improvement in the observation group, including energy, family roles, language, mobility, mood, personality, self-care, social roles, thinking, upper extremity function, vision, and work/productivity (all P < 0.05).

The researchers attribute these superior results to the hierarchical organization, which optimized the use of nursing resources, allowing staff with different levels of experience to contribute according to their specific competencies. The patient-centered model, rather than disease-centered, promoted greater patient engagement in rehabilitation and better adherence to treatment. Acupuncture contributed through the traditional Chinese medicine principles of promoting qi and activating blood, relieving blood stasis, and unblocking the meridians. The clinical implications are substantial, suggesting that the integration of hierarchical nursing care with acupuncture can accelerate neurologic recovery, significantly improve limb function, and enhance quality of life in elderly post-stroke patients.

The model offers a replicable approach to optimizing nursing resources while improving patient outcomes. However, the study has limitations, including its retrospective design, moderate sample size, single-center origin, and lack of long-term follow-up. Future multicenter prospective studies with larger samples and longer follow-up are needed to confirm these promising findings and establish standardized protocols for broader clinical implementation.