{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T02:02:49Z","timestamp":1790301769799,"version":"4.1.0"},"reference-count":26,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,10,29]],"date-time":"2025-10-29T00:00:00Z","timestamp":1761696000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Neurol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Stroke is a leading global cause of disability and mortality in adults, and early rehabilitation is critical for improving patients\u2019 functional recovery and quality of life; however, conventional rehabilitation models often focus solely on medical interventions and overlook the impact of the patient\u2019s comprehensive ecological environment on recovery, making it necessary to explore more holistic intervention approaches. To investigate the efficacy of health ecology theory-based health education in early stroke rehabilitation and its impacts on neurological\/motor\/cognitive function, psychological status, and metabolic biomarkers.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A total of 150 stroke patients during June\u2013October 2024 were randomized into control and intervention groups based on interventions. Outcomes assessed included National Institutes of Health Stroke Scale (NIHSS) for neurological deficit, Fugl-Meyer Assessment (FMA) for motor function, Modified Barthel Index (MBI) for activities of daily living, Montreal Cognitive Assessment (MoCA) for cognition, Hospital Anxiety and Depression Scale (HADS) for psychological status, and metabolic biomarkers glycated hemoglobin (HbA1c) and low-density lipoprotein cholesterol (LDL-C). Structural equation modeling (SEM) was employed to analyze path relationships among metabolic_indices, recovery_effect, and mental_status.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The intervention group demonstrated significantly greater improvement in NIHSS, FMA, MoCA, HbA1c, and LDL-C. Multivariate linear regression models showed moderate-to-substantial explanatory power, particularly for LDL-C and HbA1c (adjusted R\n                      <jats:sup>2<\/jats:sup>\n                      \u202f\u2248\u202f30%). Although models for HADS and MBI had lower explanatory power, the intervention effect remained statistically significant (\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.05). SEM revealed a significant positive path from mental_status to metabolic_indices (\n                      <jats:italic>\u03b2<\/jats:italic>\n                      \u202f=\u202f0.42). The negative path from recovery_effect to metabolic_indices (\u03b2\u202f=\u202f\u22120.45) signified that better recovery correlated with better metabolic profiles. A significant indirect effect of the intervention on metabolic_indices via improved mental_status was identified (\n                      <jats:italic>\u03b2<\/jats:italic>\n                      \u202f=\u202f1.00\u202f\u00d7\u202f0.42).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Health ecology-based health education effectively improves neurological\/motor\/cognitive function and metabolic control during early stroke rehabilitation. The intervention establishes a \u201cphysiological-psychological-social\u201d virtuous cycle through multidimensional effects, providing an innovative framework for collaborative stroke recovery management.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fneur.2025.1659024","type":"journal-article","created":{"date-parts":[[2025,10,29]],"date-time":"2025-10-29T14:18:30Z","timestamp":1761747510000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Efficacy of health ecology-based health education on early rehabilitation outcomes in stroke patients"],"prefix":"10.3389","volume":"16","author":[{"given":"Chengcheng","family":"Zhu","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chengshi","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Min","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liwei","family":"Wu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jia","family":"Liu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaoying","family":"Liu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Min","family":"Shang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ting","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yingshu","family":"Kuai","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,10,29]]},"reference":[{"key":"ref1","author":"Kim","year":""},{"key":"ref2","author":"Yang","year":""},{"key":"ref3","doi-asserted-by":"publisher","first-page":"789","DOI":"10.1097\/cin.0000000000001023","article-title":"Analysis of intensive care unit nursing clinical judgment and selection of nursing diagnosis for cerebral hemorrhage","volume":"41","author":"Yang","year":"2023","journal-title":"Comput Informat Nurs"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"451","DOI":"10.3761\/j.issn.2096-7446.2025.07.012","article-title":"Nursing care of a patient with multiple brain metastases from lung cancer and acute cerebral infarction accompanied by hemorrhage","volume":"4","author":"Lu","year":"2023","journal-title":"Chin J Emerg Crit Care Nurs"},{"key":"ref5","author":"Shu","year":""},{"key":"ref6","doi-asserted-by":"publisher","first-page":"256","DOI":"10.1186\/s12912-022-01040-8","article-title":"Effects of nursing support workers participation on negative emotions, quality of life and life satisfaction of patients with cerebral hemorrhage: a quasi-experimental study","volume":"21","author":"Luo","year":"2022","journal-title":"BMC Nurs"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"158","DOI":"10.1097\/jcn.0000000000000883","article-title":"Predictive model of self-management in patients with stroke based on the information-motivation-behavioral skills model","volume":"38","author":"Kim","year":"2023","journal-title":"J Cardiovasc Nurs"},{"key":"ref8","author":"Ito","year":""},{"key":"ref9","doi-asserted-by":"publisher","first-page":"4425","DOI":"10.1097\/ms9.0000000000001137","article-title":"Exploring the transformative influence of neuroplasticity on stroke rehabilitation: a narrative review of current evidence","volume":"85","author":"Aderinto","year":"2023","journal-title":"Ann Med Surg"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"18","DOI":"10.1177\/17474930211065917","article-title":"World stroke organization (WSO): global stroke fact sheet 2022","volume":"17","author":"Feigin","year":"2022","journal-title":"Int J Stroke"},{"key":"ref11","first-page":"91","article-title":"Take charge after stroke (TACAS): examining implementation in routine care in a stroke support service","volume":"53","author":"Bright","year":"2024","journal-title":"Cerebrovasc Dis"},{"key":"ref12","first-page":"271","article-title":"The potency of insurance program and accessibility for stroke patients routine care in Indonesia","volume":"52","author":"Fadhilah","year":"2023","journal-title":"Cerebrovasc Dis"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"145","DOI":"10.1136\/svn-2022-002179","article-title":"Enhanced diagnostic workup increases pathological findings in patients with acute ischaemic stroke: results of the prospective HEBRAS study","volume":"9","author":"Hellwig","year":"2024","journal-title":"Stroke Vasc Neurol"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"618","DOI":"10.1007\/s00784-024-06010-9","article-title":"Integrating oral health in stroke care: a critical necessity","volume":"28","author":"Jerjes","year":"2024","journal-title":"Clin Oral Investig"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"1730","DOI":"10.1111\/jocs.16397","article-title":"Routine preoperative CT: ready to roll or a step too far?","volume":"37","author":"Narayan","year":"2022","journal-title":"J Card Surg"},{"key":"ref16","doi-asserted-by":"publisher","DOI":"10.1007\/s11165-025-10245-1","article-title":"Middle school students' experiences with place-based STEM outreach","author":"Boz","year":"2025","journal-title":"Res Sci Educ"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"e0282431","DOI":"10.1371\/journal.pone.0282431","article-title":"Climate change and health in school-based education: a scoping review protocol","volume":"18","author":"Ramadani","year":"2023","journal-title":"PLoS One"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"311","DOI":"10.1155\/2022\/4372406","article-title":"Health promotion and health education: advancing the concepts","volume":"47","author":"Whitehead","year":"2004","journal-title":"J Adv Nurs"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"108382","DOI":"10.1016\/j.jstrokecerebrovasdis.2025.108382","article-title":"Tryptophan metabolites as biomarkers to predict the severity and prognosis of acute ischemic stroke patients","volume":"34","author":"Pan","year":"2025","journal-title":"J Stroke Cerebrovasc Dis"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"232","DOI":"10.1177\/154596802401105171","article-title":"The fugl-meyer assessment of motor recovery after stroke: a critical review of its measurement properties","volume":"16","author":"Gladstone","year":"2002","journal-title":"Neurorehabil Neural Repair"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"1097","DOI":"10.1080\/09638288.2022.2055166","article-title":"Comparison of responsiveness of the Barthel index and modified Barthel index in patients with stroke","volume":"45","author":"Wang","year":"2023","journal-title":"Disabil Rehabil"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"485","DOI":"10.1186\/s12888-021-03495-6","article-title":"A comparison of the Mini-mental state examination (MMSE) with the Montreal cognitive assessment (MoCA) for mild cognitive impairment screening in Chinese middle-aged and older population: a cross-sectional study","volume":"21","author":"Jia","year":"2021","journal-title":"BMC Psychiatry"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"S467","DOI":"10.1002\/acr.20561","article-title":"Measures of anxiety: state-trait anxiety inventory (STAI), Beck anxiety inventory (BAI), and hospital anxiety and depression scale-anxiety (HADS-A)","volume":"63","author":"Julian","year":"2011","journal-title":"Arthritis Care Res"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"939","DOI":"10.1007\/s11883-022-01067-x","article-title":"A contemporary review of epidemiology, risk factors, etiology, and outcomes of premature stroke","volume":"24","author":"Potter","year":"2022","journal-title":"Curr Atheroscler Rep"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"1315","DOI":"10.1556\/650.2015.30232","article-title":"Low back pain: when and what to do","volume":"156","author":"Ill\u00e9s","year":"2015","journal-title":"Orv Hetil"},{"key":"ref26","author":"Quan","year":"2024"}],"container-title":["Frontiers in Neurology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fneur.2025.1659024\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,29]],"date-time":"2025-10-29T14:18:32Z","timestamp":1761747512000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fneur.2025.1659024\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,29]]},"references-count":26,"alternative-id":["10.3389\/fneur.2025.1659024"],"URL":"https:\/\/doi.org\/10.3389\/fneur.2025.1659024","relation":{},"ISSN":["1664-2295"],"issn-type":[{"value":"1664-2295","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10,29]]},"article-number":"1659024"}}