Mary Lyons1,2, Craig Smith3,4, Elizabeth Boaden1, Marian C Brady5, Paul Brocklehurst6, Hazel Dickinson1, Shaheen Hamdy7, Susan Higham8, Peter Langhorne9, Catherine Lightbody1, Giles McCracken10, Antonieta Medina-Lara11, Lise Sproson12, Angus Walls13, Dame Caroline Watkins1,14. 1. Faculty of Health and Wellbeing, University of Central Lancashire, UK. 2. Department of International Public Health, Liverpool School of Tropical Medicine, UK. 3. Division of Cardiovascular Sciences, Manchester Academic Health Science Centre, University of Manchester, UK. 4. Department of Neurosciences, Salford Royal NHS Foundation Trust, UK. 5. Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, UK. 6. North Wales Organisation for Randomised Trials in Health, Bangor Institute of Health and Medical Research and Salford Royal NHS Foundation Trust, UK. 7. Division of Diabetes, Endocrinology and Gastroenterology, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, UK. 8. Institute of Psychology, Health and Society, University of Liverpool, UK. 9. Institute of Cardiovascular and Medical Sciences, University of Glasgow, UK. 10. Centre for Oral Health Research, School of Dental Sciences, Newcastle University, UK. 11. Health Economics Group, Medical School, University of Exeter, UK. 12. National Institute for Health Research Devices for Dignity Healthcare Technology Cooperative, Sheffield Teaching Hospitals NHS Foundation Trust, UK. 13. Edinburgh Dental Institute, College of Medicine and Veterinary Medicine, University of Edinburgh, UK. 14. Faculty of Health Sciences, Australian Catholic University, Australia.
Abstract
PURPOSE: There appears to be an association between poor oral hygiene and increased risk of aspiration pneumonia - a leading cause of mortality post-stroke. We aim to synthesise what is known about oral care after stroke, identify knowledge gaps and outline priorities for research that will provide evidence to inform best practice. METHODS: A narrative review from a multidisciplinary perspective, drawing on evidence from systematic reviews, literature, expert and lay opinion to scrutinise current practice in oral care after a stroke and seek consensus on research priorities.Findings: Oral care tends to be of poor quality and delegated to the least qualified members of the caring team. Nursing staff often work in a pressured environment where other aspects of clinical care take priority. Guidelines that exist are based on weak evidence and lack detail about how best to provide oral care. DISCUSSION: Oral health after a stroke is important from a social as well as physical health perspective, yet tends to be neglected. Multidisciplinary research is needed to improve understanding of the complexities associated with delivering good oral care for stroke patients. Also to provide the evidence for practice that will improve wellbeing and may reduce risk of aspiration pneumonia and other serious sequelae. CONCLUSION: Although there is evidence of an association, there is only weak evidence about whether improving oral care reduces risk of pneumonia or mortality after a stroke. Clinically relevant, feasible, cost-effective, evidence-based oral care interventions to improve patient outcomes in stroke care are urgently needed.
PURPOSE: There appears to be an association between poor oral hygiene and increased risk of aspiration pneumonia - a leading cause of mortality post-stroke. We aim to synthesise what is known about oral care after stroke, identify knowledge gaps and outline priorities for research that will provide evidence to inform best practice. METHODS: A narrative review from a multidisciplinary perspective, drawing on evidence from systematic reviews, literature, expert and lay opinion to scrutinise current practice in oral care after a stroke and seek consensus on research priorities.Findings: Oral care tends to be of poor quality and delegated to the least qualified members of the caring team. Nursing staff often work in a pressured environment where other aspects of clinical care take priority. Guidelines that exist are based on weak evidence and lack detail about how best to provide oral care. DISCUSSION: Oral health after a stroke is important from a social as well as physical health perspective, yet tends to be neglected. Multidisciplinary research is needed to improve understanding of the complexities associated with delivering good oral care for stroke patients. Also to provide the evidence for practice that will improve wellbeing and may reduce risk of aspiration pneumonia and other serious sequelae. CONCLUSION: Although there is evidence of an association, there is only weak evidence about whether improving oral care reduces risk of pneumonia or mortality after a stroke. Clinically relevant, feasible, cost-effective, evidence-based oral care interventions to improve patient outcomes in stroke care are urgently needed.
Authors: P Langhorne; D J Stott; L Robertson; J MacDonald; L Jones; C McAlpine; F Dick; G S Taylor; G Murray Journal: Stroke Date: 2000-06 Impact factor: 7.914
Authors: Marian C Brady; David J Stott; Christopher J Weir; Campbell Chalmers; Petrina Sweeney; John Barr; Alex Pollock; Naomi Bowers; Heather Gray; Brenda Jean Bain; Marissa Collins; Catriona Keerie; Peter Langhorne Journal: Int J Stroke Date: 2019-09-30 Impact factor: 5.266