Effect of recommended positioning on stroke outcome at six months: a randomized controlled trial.

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 (Cl -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.