O efeito das intervenções lideradas por enfermeiros na qualidade de vida de pacientes com acidente vascular cerebral: uma revisão sistemática e meta-análise

Zhong, Yan; Zhou, Min; Huang, Chang-Qin

doi:10.1590/1980-220X-REEUSP-2025-0293en

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Sumário

REVIEW • Rev. esc. enferm. USP 60 • 2026 • https://doi.org/10.1590/1980-220X-REEUSP-2025-0293en linkcopiar

O efeito das intervenções lideradas por enfermeiros na qualidade de vida de pacientes com acidente vascular cerebral: uma revisão sistemática e meta-análise

Autoria SCIMAGO INSTITUTIONS RANKINGS

Objetivos: Esta revisão sistemática e meta-análise teve como objetivo avaliar a eficácia das intervenções lideradas por enfermeiros na melhoria da qualidade de vida em indivíduos que sofreram um acidente vascular cerebral (AVC).

Métodos: Foi realizada uma busca abrangente na literatura nas bases de dados Scopus, PubMed e Web of Science, utilizando três grupos distintos de palavras-chave. Após a remoção de registros duplicados, dois revisores independentes selecionaram os artigos e extraíram os dados relevantes. Uma meta-análise foi então realizada para determinar o tamanho do efeito geral.

Resultados: A análise de todos os estudos incluídos indicou que as intervenções lideradas por enfermeiros têm um impacto notável na qualidade de vida de sobreviventes de AVC. Programas mais longos e abrangentes foram associados a maiores melhorias nos resultados de saúde mental e física. A análise conjunta demonstrou que o cuidado liderado por enfermeiros melhorou significativamente a qualidade de vida em comparação com o cuidado padrão [diferença média: 20.36 (95% CI: 4.99 – 35.73); P = 0.009; I² = 99.93].

Conclusão: As intervenções lideradas por enfermeiros são recomendadas como uma estratégia eficaz para melhorar a qualidade de vida em pacientes pós-AVC.

DESCRITORES
Papel do Profissional de Enfermagem; Cuidados de Enfermagem; Qualidade de Vida; Acidente Vascular Cerebral; Administração dos Cuidados ao Paciente

Database	Search strategy
PubMed	(“rehabilitation nursing”[Title/Abstract] OR “nurs* care”[Title/Abstract] OR “rehabilitation nurs”[Title/Abstract] OR “Nurse-led intervention”[Title/Abstract] OR “telehealth nurse”[Title/Abstract] OR “Nurs-led intervention”[Title/Abstract] OR “Nurse-led program”[Title/Abstract] OR “home care”[Title/Abstract] OR “Nurse-managed care”[Title/Abstract] OR “Nurs-managed care”[Title/Abstract] OR “Nurse-directed care”[Title/Abstract] OR “Nurs-directed care”[Title/Abstract] OR “Nurse care”[Title/Abstract] OR “Nurse-practitioner-led care”[Title/Abstract] OR “Nurs-practitioner-led care”[Title/Abstract] OR “rehabilitation nurs”[MeSH Terms] OR “rehabilitation nursing*”[MeSH Terms]) AND (“Quality of Life”[Title/Abstract] OR “Personal Satisfaction”[Title/Abstract] OR “Psychological Well-Being”[Title/Abstract] OR “Health status”[Title/Abstract] OR “Mental health”[Title/Abstract] OR “Activities of Daily Living”[Title/Abstract] OR “Health-related quality of life”[Title/Abstract] OR “HRQoL”[Title/Abstract] OR “ADL”[Title/Abstract] OR “Well-being”[Title/Abstract] OR “Life satisfaction”[Title/Abstract] OR “Activities of Daily Living”[MeSH Terms] OR “Mental health”[MeSH Terms] OR “Health status”[MeSH Terms] OR “Psychological Well-Being”[MeSH Terms] OR “Personal Satisfaction”[MeSH Terms] OR “Quality of Life”[MeSH Terms]) AND (“Stroke”[Title/Abstract] OR “Brain infarction”[Title/Abstract] OR “Brain ischemia”[Title/Abstract] OR “Ischemic stroke”[Title/Abstract] OR “Hemorrhagic stroke”[Title/Abstract] OR “Brain Diseases”[Title/Abstract] OR “Brain Injuries”[Title/Abstract] OR “Cerebrovascular Disorders”[Title/Abstract] OR “Cerebrovascular accident”[Title/Abstract] OR “CVA”[Title/Abstract] OR “Post-stroke”[Title/Abstract] OR “Stroke survivor”[Title/Abstract] OR “Cerebrovascular Disorders”[MeSH Terms] OR “Brain Injuries”[MeSH Terms] OR “Brain Diseases”[MeSH Terms] OR “Hemorrhagic stroke”[MeSH Terms] OR “Ischemic stroke”[MeSH Terms] OR “Brain ischemia”[MeSH Terms] OR “Brain infarction”[MeSH Terms] OR “Stroke”[MeSH Terms]) AND “humans”[MeSH Terms] AND “humans”[MeSH Terms] AND “humans”[MeSH Terms].
Scopus	( ( TITLE-ABS-KEY ( “rehabilitation nursing” ) OR TITLE-ABS-KEY ( “Nurse-led intervention” ) OR TITLE-ABS-KEY ( “ Nurse-led program” ) OR TITLE-ABS-KEY ( “Home care” ) OR TITLE-ABS-KEY ( “telehealth nurse” ) OR TITLE-ABS-KEY ( “Nurse-managed care” ) OR TITLE-ABS-KEY ( “Nurse-directed care” ) OR TITLE-ABS-KEY ( “rehabilitation nursing” ) OR TITLE-ABS-KEY ( “Nurse-practitioner-led care” ) ) ) AND ( ( TITLE-ABS-KEY ( stroke ) OR TITLE-ABS-KEY ( “Brain infarction” ) OR TITLE-ABS-KEY ( “Brain ischemia” ) OR TITLE-ABS-KEY ( “Ischemic stroke” ) OR TITLE-ABS-KEY ( “Hemorrhagic stroke” ) OR TITLE-ABS-KEY ( “Brain Diseases” ) OR TITLE-ABS-KEY ( “Brain Injuries” ) OR TITLE-ABS-KEY ( “Cerebrovascular Disorders” ) OR TITLE-ABS-KEY ( “Cerebrovascular accident” ) OR TITLE-ABS-KEY ( cva ) OR TITLE-ABS-KEY ( “Post-stroke” ) OR TITLE-ABS-KEY ( “Stroke survivor” ) ) ) AND ( ( TITLE-ABS-KEY ( “Quality of Life” ) OR TITLE-ABS-KEY ( “Personal Satisfaction” ) OR TITLE-ABS-KEY ( “Psychological Well-Being” ) OR TITLE-ABS-KEY ( “Health status” ) OR TITLE-ABS-KEY ( “Mental health” ) OR TITLE-ABS-KEY ( “Activities of Daily Living” ) OR TITLE-ABS-KEY ( “Health-related quality of life” ) OR TITLE-ABS-KEY ( “HRQoL” ) OR TITLE-ABSKEY ( adl ) OR TITLE-ABS-KEY ( “Well-being” ) OR TITLE-ABS-KEY ( “Life satisfaction” ) ) ) AND ( LIMIT-TO ( DOCTYPE , “ar” ) OR LIMIT-TO ( DOCTYPE , “re” ) ) AND ( LIMIT-TO ( EXACTKEYWORD , “Human” ) ) AND ( LIMIT-TO ( LANGUAGE , “English” ) ) AND ( LIMIT-TO ( SRCTYPE , “j” ) )
Web of Sciences	((TS=(“rehabilitation nursing”) OR TS=(“Nurse-led intervention”) OR TS=(“Nurse-led program”) OR TS=(“Home care”) OR TS=(“telehealth nurse”) OR TS=(“Nurse-managed care”) OR TS=(“Nurse-directed care”) OR TS=(“rehabilitation nursing”) OR TS=(“Nurse-practitioner-led care”)) AND (TS=(“Quality of Life”) OR TS=(“Personal Satisfaction”) OR TS=(“Psychological Well-Being”) OR TS=(“Health status”) OR TS=(“Mental health”) OR TS=(“Activities of Daily Living”) OR TS=(“Health-related quality of life”) OR TS=(HRQoL) OR TS=(ADL) OR TS=(“Well-being”) OR TS=(“Life satisfaction”)) AND (TS=(Stroke) OR TS=(“Brain infarction”) OR TS=(“Brain ischemia”) OR TS=(“Ischemic stroke”) OR TS=(“Hemorrhagic stroke”) OR TS=(“Brain Diseases”) OR TS=(“Brain Injuries”) OR TS=(“Cerebrovascular Disorders”) OR TS=(“Cerebrovascular accident”) OR TS=(CVA) OR TS=(“Post-stroke”) OR TS=(“Stroke survivor”)))

Author (year)	country	Study type	sample size	Gender	Mean Age (Year)	Led nurse program type	Nursing intervention duration (months)	Service providers	Outcome assessment method	Results	Outcome	Quality
Boter et al. (2004)(⁸)	Netherlands	Randomized Controlled Trial (RCT)	Case: 263 Control: 273	Both	64.5	Outreach nursing care program	5	Experienced trained stroke nurses	Short-Form Health Survey (SF-36)	Nursing intervention can subsequently affect the quality of life among the patients.	Quality of life: Mean difference: 7.9 (95% CI: 0.1 – 15.7)	H
Jönsson et al. (2014)(²¹)	Sweden	Randomized Controlled Trial (RCT)	Intervention Group: 232 Control Group: 227	Both	74.3	Nurse-led Intervention	3	Specialist nurse	EuroQol-5 Dimensions (EQ-5D)	Nursing intervention could decrease referrals, anxiety, and depression and increase self-reported health.	Referrals: Intervention group: 62% Control group: 75% (p = 0.009) Anxiety/Depression: Intervention group: 40% Control group: 52.5% (p = 0.04) Self-reported Health: Intervention group: 75% Control group: 67% (p = 0.05)	M
Deen et al. (2018)(²²)	United States	Cohort	61	Both	65.3	Stroke nurse navigation program	12	Two part-time stroke nurse navigators	EuroQol-5 Dimensions (EQ-5D)	There were significant improvements in mobility, self-care, and usual activities (p < 0.001), but no significant changes in pain/discomfort and anxiety/depression.	Mobility: (F = 4.91, p < 0.001) Self-care: (F = 6.53, p < 0.001): Usual activities (F = 3.21, p < 0.001).	M
Jie et al. (2019)(²³)	China	Randomized Controlled Trial (RCT)	82	Both	68.5	Neurological rehabilitation nursing intervention	-	Trained neurological nursing staff	Quality of life questionnaire	Quality of life and satisfaction scores in the observation group were higher than those in the control group (P < 0.05).	-	P
Ugur et al. (2019)(²⁴)	Turkey	Randomized Controlled Trial (RCT)	Intervention: 43 Control: 43	Both	76.51	Nursing care (Model of Daily Living Activities)	2.5	Public health nurses	Short-Form Health Survey (SF-36)	There were improvements in mental role and vitality among subdimensions of SF-36 (p < 0.05).	Overall: Mean difference: 10.34 (95% CI: 7.89 – 12.79) Mental Role: Mean difference: 16.28 (95% CI: 2.41 – 30.15) Vitality: Mean difference: 9.30 (95% CI: 1.63 – 16.97)	M
Zhang et al. (2019)(²⁵)	China	Randomized Controlled Trial (RCT)	Intervention: 48 Control: 48	Both	64.33	Early rehabilitation nursing	1	Advanced nurses	quality of life evaluation form	The experimental group, compared to the control group, had higher scores of quality of life after 4 weeks of intervention (P < 0.05).	-	H
Wu et al. (2015)(²⁶)	Taiwan	Cohort	Intervention Group: 41 Control Group: 41	Female	54.95	Comprehensive assessment and education for lifestyle modification, self-management strategies, social services, and physical therapy	6	Advanced practice nurses	Short-Form Health Survey (SF-36)	It was observed that there are significant improvements in physical component summary (p = 0.010) but not in mental component summary (p > 0.05).	Overall: Mean difference: 1.63 (95% CI: 1.09 – 2.17) Physical component summary: Mean difference: 4.72 (95% CI: 0.58–8.86) Mental component summary: Mean difference: 1.36 (not statistically significant).	P
Wu et al. (2020)(²⁷)	China	Randomized Controlled Trial (RCT)	Intervention Group: 30 Control Group: 31	Both	57.92	Internet-based remote rehabilitation nursing	2.5	Nurses, rehabilitation therapists, counselors, and caregivers	Stroke-Specific Quality of Life Scale (SS-QOL)	The intervention group exhibited a higher quality of life than the control group (intervention group = 190.57 ± 5.09 vs. control group = 175.90 ± 5.78, p < 0.05).	Quality of life: Mean difference: 14.67 (95% CI: 13.98 – 15.36)	M
Hu et al. (2021)(²⁸)	China	Randomized Controlled Trial (RCT)	Control Group: 70 Study Group: 53	Both	55.72	Early rehabilitation nursing	0.5	Nursing staff and rehabilitation therapists	WHOQOL-BREF for quality of life (QOL)	Nursing intervention can improve the quality of life in the patients (control group: 44.23 ± 8.93 vs study group: 58.39 ± 10.28, P < 0.05).	Quality of life: Mean difference: 14.16 (95% CI: 12.81 – 15.51)	M
Li et al. (2021)(²⁹)	China	Randomized Controlled Trial (RCT)	Control Group: 60 Observation Group: 60	Both	64.60	Interactive rehabilitation nursing	12	Nursing staff and rehabilitation therapists	Stroke Specific Quality of Life Scale (SS-QOL)	Rehabilitation nursing can enhance the quality of life in the patients (control group: 127.42 ± 7.15 vs observation group: 196.85 ± 8.31, P < 0.05).	Quality of life: Mean difference: 69.43 (95% CI: 68.27 – 70.59)	M
Liu et al. (2021)(³⁰)	China	Randomized Controlled Trial (RCT)	Control Group: 40 Experimental Group: 40	Both	Not reported	Rehabilitation nursing	3	Nursing staff and rehabilitation therapists	Stroke Specific Quality of Life Scale (SS-QOL)	The experimental group had a better quality of life than the control group (experimental group: 176.26 ± 3.69 vs control group: 190.96 ± 2.86, p < 0.05)	Quality of life: Mean difference: 14.70 (95% CI: 13.87 – 15.53)	M
Yu et al. (2021)(³¹)	China	Cohort (Prospective)	Case: 48 Contro:49	Both	66.6	Early systematic rehabilitation nursing	3	Nursing staff	Generic Quality of Life Inventory-74 (GQOLI-74)	Nursing intervention improved quality of life in the patients (experimental group: 188.85 ± 13.38 and control group: 180.80 ± 14.49, P < 0.05)	Quality of life: Mean difference: 8.05 (95% CI: 6.94 – 9.16)	M
Li et al. (2022)(³²)	China	Cohort (Retrospective)	Case: 30 Contro:30	Both	62.41 ± 3.27	Home remote rehabilitation cooperative nursing combined with home rehabilitation nursing	12	Nursing staff	Quality of life scores	Nursing intervention improved quality of life in the patients.	Overall: Mean difference: 15.75 (95% CI: 14.02 – 17.48) Psychological function: Mean difference: 16.33 (95% CI: 13.00 – 19.66) Social function: Mean difference: 15.54 (95% CI: 13.55 – 17.53) Material life: Mean difference: 16.44 (95% CI: 16.22 – 16.66) Somatic function: Mean difference: 13.22 (95% CI: 11.11 – 15.33)	P
Yang et al. (2022)(³³)	China	Randomized Controlled Trial (RCT)	Intervention Group: 55 Control Group: 55	Both	56.13	Neurology nursing intervention	-	Neurologists, nurses, and rehabilitation therapists.	Short-Form Health Survey (SF-36)	The quality of life in the intervention group was obviously higher than that in the control group (intervention group: 83.23 ± 5.87 vs control group: 72.14 ± 4.79, P < 0.05).	Quality of Life: Mean difference: 11.09 (95% CI: 10.01 – 12.17)	P
Zhang et al. (2022)(³⁴)	China	Quasi-Experimental Study	Control group: 20 Study group: 20	Both	-	Nursing and rehabilitation measures	-	Nurses and physiotherapists	Lifestyle Assessment Questionnaire (LAQ) for quality of life	Nursing intervention could improve quality of life in all dimensions of physical function, psychological function, social performance, and general health performance (P = 0.048).	-	P
Zuo and Sun (2022)(³⁵)	China	Cohort (retrospective)	Observation group: 40 Control group: 40	Both	72.33	All-inclusive and hierarchical rehabilitation nursing model combined with acupuncture	3	Nurses and rehabilitation physiotherapists	Stroke-Specific Quality of Life Scale (SS-QOL)	After nursing intervention, all dimensions of quality of life including energy, family roles, language, mobility, mood, personality, self-care, social roles, thinking, upper extremity function, vision, and work/productivity, were improved (P < 0.025).	Quality of Life: Mean difference: 1.13 (95% CI: 0.43 – 1.83)	H
He et al. (2023)(³⁶)	China	Randomized Controlled Trial (RCT)	Case group: 161 Control group: 124	Female	67.21	Nurse-led rapid rehabilitation	12	Nurses, neurologists, rehabilitation physicians, therapists, and dietitians.	EuroQol-5 Dimensions (EQ-5D)	There were substantial differences in the overall quality of life in groups (P = 0.017).	-	M
Nordin et al. (2019)(³⁷)	Malaysia	Randomized Controlled Trial (RCT)	Case Group: 45 Control Group: 46	Male	58.9	Home-based carer-assisted therapy	3	Carers (family members) trained to assist patients.	EuroQol-5 Dimensions (EQ-5D)	Significant improvements in health-related quality of life in the intervention were observed (P > 0.05).	-	H
Wang et al. (2023)(³⁸)	China	Randomized Controlled Trial (RCT)	Intervention group: 64 Control group: 64	Male	77.74	Brain-computer interface (BCI) training combined with mindfulness therapy.	6	Nurses and rehabilitation therapists	WHOQOL-BREF for quality of life	Notable improvement in the quality of life was observed in the intervention group compared to the control group. (intervention group: 66.08 ± 5.32 and control group: 55.23 ± 5.04, P < 0.001)	Quality of Life: Mean difference: 10.85 (95% CI: 9.91 – 11.79)	H
Qiao et al. (2024)(³⁹)	China	Randomized Controlled Trial (RCT)	Case group: 50 Control group: 50	Both	-	Dyadic Coping Intervention of Social Participation (DCISP)	3	Nurses for recruitment	Stroke-specific Quality of Life Scale (SS-QOL)	The intervention was linked to an improvement in quality of life (P < 0.05).	-	H
Yu et al. (2024)(⁴⁰)	China	Randomized Controlled Trial (RCT)	Case group: 50 Control group: 50	Both	66.37	Rehabilitation management based on goal management theory	-	A head nurse and experienced clinical nurses	Short-Form Health Survey (SF-36)	The observation group compared to the control group exhibited a significant enhancement in quality of life (P < 0.05).	-	M

Subgroup analysis
Subgroup	Category (number of studies)	Pooled complications (%) [95% CI]	I² (%)	Q statistic (df )	p of heterogeneity
Income level	High income (1) LMICs (6)	7.90 [0.118 – 15.68] 22.36 [5.78 – 38.95]	0 99.93	- 5	- <0.001
Region	Europe (1) Middle East (1) East /southeast Asia/Oceania (5)	7.9 [0.118, 15.68] 10.34 [7.92 – 12.76] 24.76 [6.27 – 43.25]	0 0 99.95	0 0 4	- - <0.001
Duration	Lower than 6 months (5) Higher than 6 months (2)	13.82 [12.66 – 14.98] 40.14 [-17.27 – 97.55]	72.95 99.98	4 1	0.005 <0.001
Time	2020 and before 2020 (2) After 2020 (5)	12.68 [8.44 – 16.90] 23.48 [0.55 – 46.41]	91.27 99.95	1 4	0.001 <0.001

Study, Year (reference)	Bias from randomization process	Bias from deviations in interventions	Bias from missing outcome data	Bias in outcome measurement	Bias in selection of reported results	Final risk-of-bias judgment
Boter (2004)(⁸)	Low risk	Low risk	Low risk	Low risk	Low risk	Low risk
Jönsson et al. (2014)(²¹)	Low risk	Low risk	Low risk	Low risk	Low risk	Low risk
Chen and Li (2019)(²³)	Low risk	Some concerns	Some concerns	High risk	Some concerns	High risk
Ugur et al. (2019)(²⁴)	Low risk	Low risk	Low risk	Some concerns	Low risk	Low risk
Zhang et al. (2019)(²⁵)	Low risk	Low risk	Low risk	Some concerns	Low risk	Low risk
Wu et al. (2020)(²⁷)	Low risk	Low risk	Low risk	Some concerns	Low risk	Low risk
Hu and Liu (2021)(²⁸)	Low risk	Low risk	Low risk	Some concerns	Low risk	Low risk
Li et al. (2021)(²⁹)	Low risk	Low risk	Low risk	Some concerns	Low risk	Low risk
Liu (2021)(³⁰)	Low risk	Low risk	Low risk	Some concerns	Low risk	Low risk
Yang et al. (2022)(³³)	Some concerns	Some concerns	Some concerns	High risk	Some concerns	High risk
He et al. (2023)(³⁶)	Low risk	Low risk	Low risk	Some concerns	Some concerns	Some concerns
Nordin et al. (2019)(³⁷)	Low risk	Low risk	Low risk	Low risk	Low risk	Low risk
Wang et al. (2023)(³⁸)	Low risk	Low risk	Low risk	Low risk	Low risk	Low risk
Qiao et al. (2024)(³⁹)	Low risk	Low risk	Low risk	Low risk	Low risk	Low risk
Yu et al. (2024)(⁴⁰)	Low risk	Low risk	Low risk	Some concerns	Some concerns	Some concerns

Outcomes	Risk of bias	Inconsistency	indirectness	Imprecision	Publication bias	Number (intervention/control)	SMD (95%CI)	Certainty
Quality of life	Not serious	Not serious	Seriousa	Not serious	None	553/581	20.36 (95% CI: 4.99 – 35.73)	⊕⊕◯◯ Low

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[1] H: high quality, M: moderate quality, and P: poor quality.