Objective: To evaluate the effect on patient outcome of a teaching package for nurses designed to improve the positioning of stroke patients.
Design: Cluster randomized controlled trial with six-month follow-up.
Setting: Ten stroke rehabilitation hospital units located within one UK inner city region. These were randomized to control or intervention group.
Subjects: A sample of 120 patients admitted within four weeks of a first stroke and with a hemiplegia. No eligible patient refused to participate. Eighty-three (69%) completed the study.
Intervention: All nursing staff on the intervention units received a group teaching package to improve their clinical practice in patient positioning.
Main outcome measure: Rivermead Mobility Index (RMI) at six months post stroke. Patient's position was recorded using an established observational tool.
Results: After the teaching there was some evidence of better positioning in the intervention than the control group (difference in percentage of correct positions per patient 4.9%, 95% confidence interval (CI-0.1% to 9.9%, p-0.055). There was no evidence of differences between the two groups in any of the outcome measures at six months although there was a trend towards increased elbow flexor tone in the control group.
Conclusions: A teaching intervention to improve patient positioning made no significant impact on outcome at six months post stroke. However, following the teaching there was only a slightly higher incidence of recommended patient positioning within the intervention group. Thus, a teaching package may not be powerful enough to enable any effect on patient outcome to be measured.
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