title: Effectiveness of two rehabilitation strategies provided by nurses for stroke patients in Mexico.
abstract: OBJECTIVE
  Rehabilitation strategies have been developed to improve functional state in stroke patients. The main objective of this study was to evaluate the effectiveness of the early rehabilitation at hospital and its continuity at home provided by nurses, on the functional recovery of basic and social activities in stroke patients compared with conventional care.
  
  
  METHODS
  A randomised clinical trial was carried out in three general hospitals of the Mexican Institute of Social Security (IMSS) in Mexico City between April 2003-May 2004.
  
  
  METHODS
  Stroke patients.
  
  
  METHODS
  Two rehabilitation strategies provided by nurses for stroke patients were compared: physiotherapy plus caregiver education in rehabilitation (strategy 1, S1) vs. education alone (strategy 2, S2). The main outcome variables were the basic (Barthel index) and social (Frenchay activities index) activities of daily living, of each patient. Age, sex, morbidity, stroke symptoms, complications, neurological damage (Canadian Scale), cognitive state (mini-mental state examination questionnaire) and duration of hospitalisation were defined as the control variables. Patients were evaluated at baseline and months one, three and six thereafter.
  
  
  RESULTS
  One hundred and ten patients with ischaemic stroke were enrolled and randomised; 59 were assigned to S1 and 51 to S2. Comparison of the outcome variables showed that patients improved significantly over time, but no differences were observed between groups. We observed no significant difference in strategy performance with regard to the basic and instrumental activities of daily living.
  
  
  CONCLUSIONS
  Participants who received physiotherapy with additional caregiver education benefit no more than those whose caregivers received education alone. Those countries that do not have integral rehabilitation programmes for stroke patients should understand their importance and budget resources for them. Meanwhile, both caregiver education and nurses trained in specific care and physiotherapy are alternatives that benefit these patients.
authors.affiliation: Coordination of High Specialty Medical Units, Clinical Excellence Department, Mexican Institute of Social Security, Mexico City, Mexico. laura.torres@imss.gob.mx
authors.forename: Laura del Pilar
authors.initials: Ldel P
authors.lastname: Torres-Arreola
authors.forename: Svetlana Vladislavovna
authors.initials: SV
authors.lastname: Doubova Dubova
authors.forename: Sergio F
authors.initials: SF
authors.lastname: Hernandez
authors.forename: Laura E
authors.initials: LE
authors.lastname: Torres-Valdez
authors.forename: Norma P
authors.initials: NP
authors.lastname: Constantino-Casas
authors.forename: Fernando
authors.initials: F
authors.lastname: Garcia-Contreras
authors.forename: Sara
authors.initials: S
authors.lastname: Torres-Castro
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008800:Mexico; D008875:Middle Aged; D020521:Stroke / Q000451:nursing; D000071939:Stroke Rehabilitation