Reframing physical literacy for lifelong movement and societal wellbeing: a habit-informed perspective.

Stroke is a major neurological disorder associated with high rates of disability and mortality (). In China, the incidence of stroke is on the rise with the acceleration of social aging. Despite the reduction in clinical mortality with the development of modern medical technology, approximately 75% of stroke patients have disabilities or impairments in cognition, self-care ability, activities of daily living, treatment compliance, and psychology after onset, which seriously affects patients’ quality of life and increases the family and social burden (). Rehabilitation for patients is a long-term process that requires professional medical support. However, many discharged patients with stroke sequelae face challenges such as limited community medical resources, unsound social support system (), and family members’ lack of professional medical knowledge. As a result, they fail to get professional follow-up nursing and rehabilitation treatment, leading to repeated hospitalizations. This places a significant financial and mental strain on themselves and their families (). Therefore, the post-discharge rehabilitation and prognosis of patients with stroke sequelae have received widespread attention. A medical treatment combination suggests that public medical institutions of different types and levels in a region are combined into a cooperative alliance or medical group as a community of shared interests and a community of shared responsibilities to realize the sharing of medical resources, the interconnection of medical information, and the homogenization of medical services (). Since the 1970s, foreign medical treatment combinations have established a relatively mature system after years of development. Foreign continuous nursing, first proposed by the College of Nursing at the University of Pennsylvania in the 1980s, can effectively improve the prognosis of various diseases at low cost () and is delivered within a relatively mature medical treatment combination service system (). In China, patients prefer large hospitals with abundant high-quality medical resources to community medical institutions, which are deficient in both resources and capacity. Establishing a combination of medical treatments is an effective way to implement tiered diagnosis and treatment () and an important measure to deepen medical and health system reforms, optimize the structure, and adjust the allocation of medical resources (). As the incidence of chronic diseases increases in China, continuous nursing services have received widespread attention, and a significantly increasing number of studies have been conducted, mainly involving stroke, diabetes, hypertension, and other chronic diseases. A review of literature indicates that the majority of studies have focused on continuous nursing carried out in tertiary hospitals, mainly on specific diseases and the effect of continuous nursing. While hospital-community linkage models have been proposed previously, the majority of studies lack standardized protocols, quantified training requirements, and detailed implementation parameters. To explore the clinical effect of a medical treatment combination-based continuous nursing model on patients with stroke sequelae, a vertical continuous nursing network system was established based on medical treatment combination. A continuous nursing group was formed by tertiary medical institutions, aiming to improve the professional knowledge and skills of medical workers through theoretical teaching, operation training, business guidance, case discussion, and other training, and to provide guidance for community medical institutions in completing stroke sequelae-related continuous nursing activities in a home environment by telephone follow-up, family visit, health education and consultation based on a network platform, and other methods. This ensured that the discharged patients with stroke sequelae had a smooth transition and had access to continuous and homogeneous health nursing services in their homes, which improved their quality of life and reduced complications. Details are reported as follows: A total of 60 patients with stroke sequelae admitted to the Neurology Department of our hospital from April 2019 to March 2020 were selected, and the study was approved by Taihe Hospital’s Ethics Committee. All patients met the clinical diagnostic criteria for stroke and gave informed consent, and those with serious dysfunction of important organs such as the heart, lung, liver, and kidney, as well as serious mental disorders, cognitive disorders, and malignant tumors, were excluded. The patients were randomized as described in the randomization and blinding section below. After exclusions and dropouts, 30 patients per group completed the study and were included in the final analysis. In the treatment group, there were 18 men and 12 women, aged 38–78 years, with an average age of 52.07 ± 10.15 years. The number of days after stroke was 1–10 days, with an