INTRODUCTION:

Stroke continues to be a leading cause of mortality and long-term disability globally, exerting immense pressure on healthcare systems and families. The incidence of stroke is expected to rise with the aging of the population and the increased prevalence of risk factors such as hypertension, diabetes, and sedentary lifestyles.

Despite advancements in acute care and rehabilitation, stroke recovery remains a critical challenge, necessitating timely interventions to reduce complications and improve overall patient outcomes¹.

Stroke is one of the leading causes of long-term disability that significantly affects patients’ quality of life, primarily due to impaired mobility, communication difficulties, and loss of functional independence. Rehabilitation programs have been shown to reduce the impact of stroke by improving functional abilities and daily living skills. Neurological Rehabilitation Interventions (NRI) have demonstrated effectiveness in reducing functional disability among stroke patients, thereby contributing positively to quality of life⁷. Similarly, structured Comprehensive Nursing Rehabilitation Programmes have also improved the overall quality of life among patients in the post-acute phase of stroke⁸. These findings underscore the importance of holistic rehabilitation approaches that focus not just on physical recovery but also on psychosocial well-being.

Another important aspect of stroke recovery is the involvement of caregivers in the rehabilitation process. Caregivers’ knowledge and positive attitudes toward home care management play a critical role in maintaining continuity of care and enhancing patient outcomes⁹. In addition, assistive devices such as rehabilitative finger mounts have been developed to aid finger movement in chronic stroke patients, contributing to improved hand function and independence in daily activities¹⁰. Beyond assistive technology, regular physical activity for both upper and lower limbs has been linked with improved body composition and functional mobility, particularly in female post-stroke patients¹¹. These interventions collectively strengthen the role of both caregiver empowerment and technological support in enhancing quality of life.

Physical and cognitive rehabilitation exercises are also crucial components of post-stroke recovery. Balance and coordination can be restored through stepping exercises, which help improve lower limb strength and gait stability¹², while scapula setting interventions positively influence activities of daily living and independent walking¹³. Moreover, dual-task aerobic exercises have been associated with not only improved physical performance but also enhanced cognitive functioning through stimulation of neurotrophic factors¹⁴. Targeted interventions such as ankle strategy exercises with visual feedback further contribute to proprioception and balance improvements¹⁵. Finally, timely medical intervention in ischemic stroke, reflected in reduced onset-to-door time, has shown a correlation with better preservation of cognitive function, a key determinant of long-term quality of life¹⁶.

Awareness about stroke symptoms and risk factors plays a pivotal role in ensuring early intervention and reducing debilitating outcomes. Studies have demonstrated that insufficient public and patient knowledge often leads to delayed treatment, which adversely affects recovery and survival rates. Comprehensive educational initiatives targeting both patients and caregivers are therefore vital for prompt recognition of warning signs and access to medical care².

The multifaceted consequences of stroke extend beyond physical impairment, impacting psychological well-being, social integration, and daily functioning. As a result, quality of life for stroke survivors is frequently diminished. Current rehabilitation strategies emphasize not only enhancing physical abilities but also addressing cognitive, emotional, and social challenges. However, there is a distinct need for integrated approaches that holistically address these interconnected domains through structured intervention programs³.

Caregiver burden is another important facet, as families and close associates of stroke survivors often shoulder extensive and ongoing responsibilities. This burden, if unmitigated, can lead to negative health outcomes for both caregivers and patients. Effective interventions designed to increase stroke awareness, strengthen rehabilitation, and provide psychosocial support are essential for alleviating caregiver stress while simultaneously improving patient quality of life⁴

MATERIALS AND METHODS:

Materials:

This true experimental study was conducted among stroke patients admitted to selected hospitals in Kerala to evaluate the impact of a Comprehensive Interventional Package (CIP) on stroke awareness and quality of life (QOL), as well as to investigate associations with socio-demographic variables⁵. The study design incorporated random allocation, pre- and post-test assessments, and a control group, aligning with standard quantitative research protocols to rigorously evaluate intervention effects⁶.

Study Population and Sampling:

The study population comprised adult patients (aged 30-60 years) diagnosed with stroke, as confirmed by clinical evaluation and radiological imaging (CT scan), and admitted for regular treatment at the chosen hospitals⁵. A total of 200 eligible respondents were selected using simple random sampling and equally divided into control and experimental groups (n=100 each) based on predetermined inclusion criteria: modified Rankin scale score 1-4, conscious, alert, able to communicate in Hindi or English, accompanied by a caregiver, and willing to give informed consent. Exclusion criteria included refusal to participate, significant communication difficulties (other than stuttering), complete blindness, or other serious comorbid illness⁵.

Ethical Considerations:

Ethical approval was obtained from the Institutional Ethics Committee. Written informed consent was secured from all participants after a clear explanation of the study objectives and assurance of confidentiality and voluntary participation⁵.

Data Collection Tools:

Three instruments were employed:

· Demographic profile: Detailed information about age, sex, marital status, educational background, occupation, monthly income, type, and duration of stroke was collected⁵.

· Stroke Knowledge Test (SKT): A validated 20-item multiple-choice questionnaire, scored from 0-20, assessed knowledge regarding risk factors, symptoms, and management. Scores were categorized as excellent (19-20), good (16-18), average (12-15), or poor (<12). Reliability was established with an ‘r’ value of 0.71⁵.

· Stroke-Specific Quality of Life Scale (SS-QOL): The 49-item scale evaluated 12 domains of QOL on a 5-point Likert scale, with total scores categorized into severe (0-24), moderate (25-49), mild (50-74), and minimal/no (75-100) impairment⁵.

Intervention:

The experimental group received the CIP, which consisted of structured education (lectures, demonstrations, print/audio-visual materials), rehabilitation strategies (physiotherapy, occupational therapy), counseling, and lifestyle modification support over three daily inpatient sessions (40 minutes each)⁵. The control group received routine standard care⁵.

Procedure:

Baseline (pre-test) data were collected after formal permissions. The intervention was delivered to the experimental group, followed by post-test assessments using the same tools in both groups. Data collection was completed under the direct supervision of the research and clinical team, ensuring fidelity and consistency of intervention delivery⁵.

Statistical Analysis:

Data were analyzed using SPSS (Statistical Package for Social Sciences). Descriptive statistics (mean, SD, frequencies) outlined demographic characteristics and test scores. Paired t-tests were used for within-group comparisons of pre- and post-intervention scores, while chi-square tests evaluated associations between socio-demographic variables and baseline measures⁵. A p-value <0.05 was considered statistically significant.

RESULT:

Demographic Profile of Participants

A total of 200 stroke patients participated in the study. Their demographic details are as follows:

Table 1: Demographic Distribution of Samples

Variable	Category	Frequency (%)
Age	30-40	20 (10)
	41-50	60 (30)
	51-60	120 (60)
Gender	Male	136 (68)
	Female	64 (32)
Marital Status	Married	154 (77)
	Unmarried	2 (1)
	Divorced	18 (9)
	Widowed	26 (13)
Education	Illiterate	36 (18)
	Primary	102 (51)
	Secondary	42 (21)
	Higher Secondary	18 (9)
	Graduate and above	2 (1)
Occupation	Employed	45 (22.5)
	Unemployed	95 (47.5)
	Retired	22 (11)
	Student	2 (1)
	Homemaker	36 (18)
Monthly Income	Below ₹10,000	24 (12)
	₹10,001-20,000	128 (64)
	₹20,001-50,000	44 (22)
	Above ₹50,000	4 (2)
Type of Stroke	Ischemic	112 (56)
	Hemorrhagic	88 (44)
Duration of Stroke	<1 yr	6 (3)
	1-3 yrs	76 (38)
	4-5 yrs	86 (43)
	>5 yrs	32 (16)

Impact of Comprehensive Intervention on Stroke Awareness

Stroke Knowledge Test (SKT) Scores

Interpretation:

There was a significant increase in quality of life among stroke patients who received the intervention. Severe and moderate impairment dropped, while minimal/no impairment rose. The mean SS-QOL score increased by 8.69, supported by a statistically significant paired t-value (p<0.05).

Associations with Socio-demographic Variables:

No significant association was found between socio-demographic variables (age, sex, education, income, type of stroke, stroke duration) and pretest scores for either awareness or QOL (p>0.05 for all). Improvements were observed regardless of background characteristics.

Summary of Key Results:

· Stroke awareness and QOL scores improved significantly after the intervention package.

· The intervention led to marked reduction in poor knowledge and severe/moderate QOL impairment.

· Gains were consistent across demographic subgroups.

DISCUSSION:

The findings from this true experimental study provide compelling evidence that a Comprehensive Interventional Package (CIP) markedly enhances both stroke awareness and quality of life among stroke patients. The significant improvement in post-intervention Stroke Knowledge Test (SKT) scores, supported by a notable mean difference and paired t-value, underscores the effectiveness of multifaceted educational and rehabilitative strategies. These results are consistent with literature reporting that patient-centered interventions can bridge existing knowledge gaps and empower individuals to recognize stroke symptoms promptly, which is essential for reducing pre-hospital delays and improving clinical outcomes.

Moreover, the upward shift in Stroke-Specific Quality of Life Scale (SS-QOL) scores and the reduction in the proportion of patients with severe or moderate impairment highlight the broader impact of CIP beyond knowledge transmission. Incorporating physiotherapy, counseling, and lifestyle modification components addressed not only the patients’ physical recovery but also their psychological and social adaptation following stroke. This holistic approach mirrors the current recommendations for stroke rehabilitation and confirms that integrated care is vital for sustained quality of life improvement.

It is noteworthy that the efficacy of the intervention was robust across various socio-demographic subgroups, with statistical analyses revealing no significant associations between baseline awareness or QOL and factors such as age, sex, education, or income. This suggests the CIP’s potential for broad applicability across diverse patient populations, making it adaptable for widespread implementation in resource-variable settings.

These outcomes support the paradigm shift towards multidisciplinary, patient-focused stroke rehabilitation models and call for further research to assess long-term sustainability and scalability.

CONCLUSION:

The findings of this true experimental study demonstrate that the Comprehensive Interventional Package (CIP) is highly effective in improving both stroke awareness and quality of life among stroke patients. Statistically significant increases in post-intervention knowledge and quality of life scores, along with marked reductions in the proportion of patients with poor awareness and severe to moderate impairment, underscore the positive impact of a structured, multidimensional approach to stroke education and rehabilitation. Moreover, the intervention proved beneficial across diverse demographic backgrounds, suggesting its generalizability and potential scalability in various healthcare settings. By integrating patient education, rehabilitation therapy, and psychosocial support, the CIP addresses key challenges in post-stroke care and supports a holistic recovery process. These results advocate for the adoption of comprehensive, patient-centered intervention programs as a standard component of stroke management to promote sustainable health and well-being outcomes among stroke survivors.

CONFLICT OF INTEREST:

There are no conflicts of interest to declare in this study. The research was independently conducted by the investigator. No external financial support, commercial sponsorship, or influence from pharmaceutical, device companies, or other organizations was associated with any phase of the research, data collection, analysis, or reporting. All ethical guidelines and institutional protocols were strictly followed, and the outcomes presented reflect the independent findings and professional judgment of the author.

ACKNOWLEDGMENTS:

The author would like to thank Dr. Nisha. S, Principal, Red Crescent College of Nursing, Kerala

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Received on 21.08.2025 Revised on 04.09.2025

Accepted on 18.09.2025 Published on 25.10.2025

Available online from November 04, 2025

Asian J. Nursing Education and Research. 2025;15(4):226-230.

DOI: 10.52711/2349-2996.2025.00046

This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. Creative Commons License.

Interpretation	Pretest n (%)	Mean (SD)	Posttest n (%)	Mean (SD)	Mean Diff. (Δ%)	Paired t-value
Excellent (19–20)	12 (6)	11.76 (4.6)	19 (9.5)	14.46 (2.66)	+2.7 (13.5%)	14.35
Good (16–18)	26 (13)		38 (19)
Average (12–15)	98 (49)		136 (68)
Poor (<12)	64 (32)		7 (3.5)

QOL Level (SS-QOL Score)	Pretest n (%)	Mean (SD)	Posttest n (%)	Mean (SD)	Mean Diff.	Paired t-value
Severe (0–24)	8 (4)	53.1 (20)	6 (3)	61.8 (8.9)	8.69	6.14
Moderate (25–49)	88 (44)		48 (24)
Mild (50–74)	72 (36)		89 (45)
Minimal/ No impairment (75–100)	32 (16)		57 (29)