Advanced oral hygiene care programmes improve quality of life during stroke rehabilitation
Advanced oral hygiene care programmes (AOHCP) yield better health-related quality of life (HRQoL) and oral (O)HRQoL for patients receiving outpatient stroke rehabilitation than conventional oral hygiene care programmes (COHCP), a new randomized clinical trial has found.
“This study provided the evidence that the AOHCP was more effective than the COHCP within stroke rehabilitation in improving subjective health,” wrote researchers.
Discharged stroke patients (n=94) who received continued outpatient rehabilitation were recruited and randomized to receive either COHCP (n=47) or AOHCP (n=47). Both programmes involved brushing with a standardized toothpaste and receiving oral hygiene training, while the AOHCP had an additional powered toothbrush and mouth rinse.
Study outcomes were HRQoL and OHRQoL, measured by the Short Form Health Survey (SF-12), Oral Health Impact Profile 14 (OHIP-14), Geriatric Oral Health Assessment Index (GOHAI) and Oral Health Transition Scale (OHTS).
At 3 months, the AOHCP group had significantly higher GOHAI (p<0.05), lower OHIP-14 (p<0.01) and lower OHTS (p<0.001) scores compared with baseline values. In contrast, those who received COHCP did not show significant changes in any of the scores. [Sci Rep 2017;7:7632]
Regression analyses showed that the oral hygiene intervention was significantly associated only with GOHAI scores at 6 months (standardized coefficient, -0.16; p=0.019) and with OHTS scores at 3 months (standardized coefficient, 0.19; p<0.007). No significant associations between the intervention and OHIP-14 were observed.
On the other hand, plaques at baseline were significantly correlated with GOHAI scores both at 3 (standardized coefficient, -0.2; p<0.01) and 6 (standardized coefficient, -0.17; p=0.016) months. Corresponding baseline scores were also significantly correlated with GOHAI, OHIP-14 and OHTS scores at 3 and 6 months.
“Findings from the regression analyses identified a significant association between intervention and OHRQoL at the end of the clinical trial when assessed by OHTS but not by GOHAI or OHIP-14. This suggests that OHTS is more sensitive to oral hygiene care intervention than GOHAI or OHIP-14,” noted researchers.
Moreover, the baseline OHIP-14 and GOHAI scores of the study participants were comparable to those of a healthy population, suggesting impaired “ability to capture the improvements caused by interventions,” added researchers.
In terms of general HRQoL, both AOHCP and COHCP groups showed 3-month significant improvements in physical component summary (PCS; p<0.001 and p<0.05, respectively) and mental component summary (MCS; p<0.05 and p<0.01, respectively) scores compared with baseline values.
There were no significant between-group differences in terms of MCS and PCS both at baseline and at 3 months.
In the final models, which combined PCS and MCS with the OHRQoL measures individually, the oral hygiene intervention was significantly associated with PCS scores at 3 (standardized coefficient, -0.19; p=0.027) and 6 (standardized coefficient, -0.21; p=0.032) months. In contrast, MCS scores were not significantly associated with the intervention at either timepoint.
“There were significant improvements in PCS and MCS score among all participants. This concurs with other reports of improvement in physical health and mental health following rehabilitation among stroke survivors,” said researchers. [Stroke 2003;34:801-805; Am J Phys Med Rehabil 2006;85:831-838]
“Of note, an observed greater significant magnitude of improvement was in physical health than mental health. This may be due to the physical exercise components of the general rehabilitation programmes, although it is acknowledged that there are some mental health benefits from such physical exercises as well,” they added.