{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,27]],"date-time":"2026-05-27T14:06:38Z","timestamp":1779890798436,"version":"3.53.1"},"reference-count":27,"publisher":"BMJ","issue":"5","license":[{"start":{"date-parts":[[2026,5,26]],"date-time":"2026-05-26T00:00:00Z","timestamp":1779753600000},"content-version":"unspecified","delay-in-days":25,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"Bengbu Medical University Natural Science Key Project","award":["2023byzd250"],"award-info":[{"award-number":["2023byzd250"]}]},{"name":"Hefei Second People\u2019s Hospital Research Project","award":["2025ykt003"],"award-info":[{"award-number":["2025ykt003"]}]},{"name":"Anhui Traditional Chinese Medicine Inheritance and Innovation Research Project","award":["2025CCCX176"],"award-info":[{"award-number":["2025CCCX176"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2026,5,14]]},"published-print":{"date-parts":[[2026,5]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>\n                      Stroke is the leading cause of death and disability among adults in China, with a growing disease burden. Data from the\n                      <jats:italic>China Stroke Prevention and Treatment Report 2023<\/jats:italic>\n                      show that the incidence rate of stroke in China is approximately 246.8 per 100\u2009000 population, with over 2\u2009million new cases annually. Among surviving patients, 60%\u201370%\u2009experience varying degrees of hand dysfunction after discharge, and only 10%\u201320%\u2009can recover to near-normal levels. As the most refined and core motor function of the human body, hand function recovery essentially reflects motor cortical neuroplasticity (synaptic remodelling and cortical reorganisation). Its recovery directly affects the independence of activities of daily living (ADLs) such as eating, dressing and personal hygiene, markedly reducing quality of life and increasing family care burden and social medical costs.\n                    <\/jats:p>\n                    <jats:p>Currently, clinical rehabilitation interventions for patients who had a stroke are mostly concentrated during hospitalisation, focusing on acute-phase stability and basic function recovery. However, postdischarge rehabilitation follow-up coverage is fewer than 40%, and community rehabilitation resources are disparately distributed, leaving most patients facing the dilemma of \u2018interrupted rehabilitation after discharge\u2019. Additionally, existing studies mostly focus on short-term follow-up (3\u20136\u2009months) and lack systematic investigation of the long-term trajectory of hand function recovery (6\u2009months to 1 year), key turning points and influencing factors\u2014especially the regulatory role of multidisciplinary intervention on neuroplasticity. The integrated \u2018hospital-community-family\u2019 multidisciplinary collaborative management model remains underdeveloped.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>This study aims to describe the dynamic trajectory of hand function and overall rehabilitation outcomes in patients who had a stroke at 6\u2009months and 1 year postdischarge, analyse the key influencing factors of hand function recovery (with a focus on the regulatory role of multidisciplinary collaborative intervention on motor cortical neuroplasticity), verify the effectiveness of the multidisciplinary collaborative management model on complications and rehabilitation satisfaction, and ultimately construct a continuous rehabilitation management model adapted to the current status of primary medical care in China.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A single-centre, prospective cohort study design will be used. A total of 120 patients who had a stroke with hand dysfunction discharged from the Department of Rehabilitation Medicine, The Second People\u2019s Hospital of Hefei Guangde Road Campus between February 2026 and February 2027 will be enrolled. A multidisciplinary team (MDT) consisting of rehabilitation physicians, rehabilitation therapists, community doctors\/nurses and family caregivers will be established to implement a three-stage intervention: discharge connection, community intervention and online support (incorporating neuroplasticity initiation, enhancement and maintenance strategies).<\/jats:p>\n                    <jats:p>Hand function (primary outcome) will be assessed using the Fugl-Meyer Assessment for Hand (FMA-Hand) at baseline (1\u20133\u2009days predischarge, T0), 3\u2009months postdischarge (T1), 6\u2009months postdischarge (T2) and 12\u2009months postdischarge (T3). Secondary outcomes include overall motor function (FMA Total Score, FMA-Total) and ADL (Modified Barthel Index). Influencing factor data will be collected using structured questionnaires, and neuroplasticity will be indirectly evaluated using transcranial magnetic stimulation-derived motor evoked potentials.<\/jats:p>\n                    <jats:p>SPSS V.26.0 software will be used for statistical analyses. Quantitative data will be expressed as (x\u0304\u00b1s) or (M (IQR)) depending on normality; categorical data will be presented as (n (%)). Repeated measures analysis of variance will compare functional changes across time points, and multiple linear regression will identify independent influencing factors of hand function recovery.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Expected results<\/jats:title>\n                    <jats:p>Patients will show progressive hand function recovery within 1 year after discharge, with the fastest recovery at 3\u20136\u2009months and stabilisation from 6 to 12\u2009months. Younger age, higher baseline function, better rehabilitation adherence and active multidisciplinary intervention are associated with greater neuroplasticity and better hand function recovery. The MDT model may reduce complications and improve rehabilitation satisfaction and ADL.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The results of this study will fill the data gap in long-term postdischarge rehabilitation trajectories of patients who had a stroke, clarify the regulatory role of multidisciplinary collaborative intervention on motor cortical neuroplasticity and provide scientific evidence and practical references for optimising postdischarge rehabilitation follow-up programmes and improving the primary rehabilitation service system.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Ethics and dissemination<\/jats:title>\n                    <jats:p>This study was approved by the Biomedical Research Ethics Committee of The Second People\u2019s Hospital of Hefei (No. 2024-KY-089). Written informed consent was obtained from all participants. The results will be published in peer-reviewed journals and disseminated to participants and community health institutions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration number<\/jats:title>\n                    <jats:p>ChiCTR2600119007.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2026-116644","type":"journal-article","created":{"date-parts":[[2026,5,27]],"date-time":"2026-05-27T12:00:41Z","timestamp":1779883241000},"page":"e116644","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Follow-up monitoring, rehabilitation status and hand function recovery in patients who had a stroke at 1 year after discharge (FOLLOW-STROKE-HAND): protocol for a longitudinal observational 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