Evidence-based nursing interventions in cognitive dysfunction among adults with brain injury: a quasi-experiment.

Abstract

Background: While evidence-based interventions are increasingly used in cognitive care, their effectiveness for patients with brain injury remains not well established. Therefore, we aimed to compare the effects of an evidence-based nursing intervention programme vs. conventional nursing care in patients with cognitive dysfunction following brain injury.

Methods: We enrolled brain injury patients from two neurosurgical wards (A and B) of a Shanghai rehabilitation hospital (July 2023-January 2024) in a non-randomised controlled trial. Ward A implemented the evidence-based cognitive intervention programme, while ward B maintained routine care. The segregated ward design prevented cross-contamination between groups. Outcomes were measured at baseline, immediately after a two-week intervention (T1), and at a four-week follow-up (T2). We analysed primary (i.e. the Mini-Mental State Examination (MMSE)) and secondary (i.e. activities of daily living (ADL) and cognitive knowledge scores) outcomes using generalised estimating equations (GEE) with terms for time, group, and their interaction. We set statistical significance at P < 0.05.

Results: We enrolled 124 brain injury patients with cognitive dysfunction, with 117 completing the study (intervention n = 59; control n = 58; attrition = 5.6%). No significant differences were found between the groups at baseline. The GEE results showed significantly higher cognitive function improvements in the intervention group than the control group at both T1 (b = 1.71; 95% confidence interval (CI) = 0.76, 2.66; P < 0.001) and T2 (b = 2.71; 95% CI = 1.42, 4.00; P = 0.001). Results also showed a significantly greater increase in ADL (b = 4.93; 95% CI = 2.14, 7.72; P = 0.001) and caregivers' cognitive scores (b = 8.09; 95% CI = 2.78, 13.41; P = 0.003) at T1, with sustained increases at T2 in ADL (b = 5.46; 95% CI = 2.15, 8.77; P = 0.001) and caregivers' cognitive scores (b = 13.51; 95% CI = 6.76, 20.27; P < 0.001).

Conclusions: The programme was effective in improving cognitive function and shows potential for clinical implementation and generalisation. A longer follow-up study is needed to evaluate its long-term effects on clinical outcomes.

Registration: We prospectively registered this study with the Chinese Clinical Trial Registry (Registration ID: ChiCTR2300072283).