Multicentre randomised clinical trials to promote oral health care for stroke survivors during rehabilitation

Abstract

Objectives: This thesis aimed to evaluate the effectiveness of oral health promotion interventions to improve oral health care for stroke survivors by: i) stroke-care nurses and ii) stroke survivors themselves.

Methods: Two multi-centres trials were conducted. In trail 1, nurses were randomly assigned by centre, to receive a Web-based continual professional development (CPD) programme using computer-aided learning (CAL) based on the ‘Theory of Planned Behaviour’ (TPB) [Theory Web-based CPD-CAL] or a Non-theory Web-based CPD-CAL: test group versus control group. Assessments of ‘intention to’ and ‘performance of’ oral hygiene care were conducted pre-intervention, at 1-month and 6-month post-intervention. In trail 2, stroke survivors were randomly assigned into either (i) test group - ‘Intense Oral Hygiene Care’ [powered toothbrushing and antimicrobial gel (1% chlorhexidine gluconate) daily], or (ii) control group - ‘Conventional Oral Hygiene Care’ (manual toothbrushing and commercially available dentifrice daily). Assessments of dental plaque and oral pathogens (yeast, aerobic and facultative anaerobic Gram-negative bacilli (AGNB) and Staphylococcus aureus were conducted pre-intervention, at 3-month and 6-month post-intervention.

Results: The response rate to trial 1 was 68.2% (373/547). At 1-month, compared to the control group, the test group recipients had significant greater improvements in ‘attitudes’ (P<0.01) and ‘subjective norms’ (P<0.05) to provide oral hygiene care. At 6-month, compared to the control group, the test group recipients had significant greater improvements in ‘intention to’ to provide oral hygiene care (P<0.01); as well as greater improvements in ‘attitudes’ (P<0.01) and ‘subjective norms’ (P<0.001). The response rate to trial 2 was 62.7% (54/86). At 3-month and 6-month, significant reductions in dental plaque levels were evident among the test group (P<0.001) and among the control group (P<0.001). However, no significant differences in dental plaque levels were evident between groups (P>0.05). In terms of oral pathogens, the prevalence of yeast at 6-month was lower in the test group compared to the control group (P<0.05). In the test group significant reductions in the prevalence of the yeast C. albicans was observed over time (P<0.05), but not in the control group (P>0.05). In both groups there were significant reductions in the prevalence and viable counts of AGNB: test (P<0.05) and control (P<0.05) groups; but no significant difference between them (P>0.05). In both groups there were significant reductions in the prevalence of the AGNB species K. pneumoniae: test (P<0.01) and control (P<0.01) groups; but no significant difference between them (P>0.05). Among the test group there was a significant reduction in S. aureus (P<0.01) but not in the control group (P>0.05); and no significant difference was observed between groups (P>0.05).

Conclusion: Trail 1: The test intervention (TPB theory Web-based CPD-CAL) was more effective at improving general ‘intention to’ provide oral hygiene care than the control intervention (Non-theory Web-based CPD-CAL). Trial 2: The ‘Intense Oral Hygiene Care’ intervention and the ‘Conventional Oral Hygiene Care’ intervention were effective in dental plaque control; and of comparable effectiveness. The ‘Intense Oral Hygiene Care’ intervention was more effective than the ‘Conventional Oral Hygiene Care’ intervention in the control of some oral pathogens