Stroke patients spend only short periods of time during the day on therapeutic activities. For the largest part of the day, the patient is alone and passive. A challenge for nurses is how to activate patients and engage them in purposeful task-oriented training in daily activities.

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.

BackgroundRecovery after stroke is dependent on how much time can be spent on rehabilitation. Recently, we found that therapy time for older stroke patients on a rehabilitation unit of a nursing home could be increased significantly from 8.6 to at least 13 hours a week. This increase was attained by the implementation of interventions, focused on strength, mobility and balance. Nurses carried out these exercises with the patients during their daily activities. The aim of the present study is to investigate if increased therapy time has a positive effect on cognition, mood (depression and anxiety), and ADL in stroke patients.MethodsA comparative single blind controlled study will be applied. Patients suffering from a stroke and staying on one of the rehabilitation units of the nursing homes are eligible for participation. Participants belong to the intervention group if they stay in two nursing homes where four interventions of the Clinical Nursing Rehabilitation Stroke Guideline were implemented. Participants who stay in two nursing homes where therapy is given according to the Dutch stroke Guideline, are included in the control group. Clinical neuropsychologists will assess patients’ cognitive functioning, level of depression (mood) and anxiety. Nurses will assess a Barthel Index score on a weekly basis (ADL). These variables are measured at baseline, after 8 weeks and at the moment when participants are discharged from the nursing home.DiscussionThe present study evaluates the effect of increased therapy time on cognition, mood (level of depression and anxiety), and ADL in stroke patients. When positive effects will be found this study can guide policy makers and practitioners on how to implement more therapy time on rehabilitation wards of nursing homes.Trial registrationTNR Our study has been documented in the Dutch Trial Registration, TC = 3871.

From a clinical point of view, we suggest combining physical and cognitive training from the very early phase of recovery.