Early nursing interventions in post-stroke neurological rehabilitation: a comprehensive review of evidence predominantly from high-resource settings.

Abstract

Stroke remains a leading cause of death and acquired long-term disability worldwide, and the earliest days after onset frequently shape the safety, intensity, continuity, and person-centeredness of subsequent rehabilitation. Early rehabilitation is delivered by interprofessional teams, within which nurses make a distinctive contribution through continuous surveillance, repeated bedside implementation of agreed plans, prevention of avoidable complications, and coordination across shifts and settings. This comprehensive review synthesizes contemporary evidence relevant to early nursing contributions in post-stroke neurological rehabilitation for ischemic and hemorrhagic stroke. Guidelines, systematic reviews, randomized trials, and nursing-science sources were identified through structured searches of MEDLINE, CINAHL, Embase, the Cochrane Library, and named guideline and professional-society resources, then synthesized narratively using a transparent, criteria-based appraisal of evidence strength. Central themes include neurological surveillance, swallow safety, positioning and limb protection, readiness-based mobilization, prevention of immobility-related and iatrogenic complications, communication and cognitive support, mood and fatigue care, dignity-preserving continence rehabilitation, education, secondary prevention, and transitions of care. The strongest evidence supports organized stroke-unit care, timely swallow screening, protocolized management of fever, glycemia, and swallowing, appropriate mechanical venous thromboembolism prevention, and early supported discharge for selected patients. Evidence is more mixed for very early high-dose mobilization, routine splinting, several oral care protocols, and some digital interventions. Most included evidence was generated in high-resource stroke systems, and transferability to lower-resource settings requires contextual adaptation. Early nursing interventions are most effective when their nursing-led and shared components are clearly delineated within standardized yet individualized interprofessional pathways that preserve physiologic stability, dignity, equitable access, and long-term participation.