Highlights
- •The Japanese guideline recommend multidisciplinary team approach for stroke dysphagia patients.
- •The strategies to effectively utilise a multidisciplinary team have not been elucidated.
- •Combined early oral healthcare and early mobilisation deceased the stroke-associated pneumonia incidence within 7days.
- •Combined early intervention decreased the number of patients who need medical care after rehabilitation.
Abstract
Objective
To investigate the effects of combined early oral healthcare and early mobilisation
on the incidence of stroke-associated pneumonia during hospitalisation of acute stroke
patients.
Materials and methods
In this single-centre, non-blinded, before-and-after cohort study, patients received
basic stroke rehabilitation by a multidisciplinary team within 72 h of symptom onset
from July to September 2016 and from July to September 2018. Patients were divided
into two groups: 1) patients who received combined early oral healthcare and early
mobilisation (early intervention group) (n=107), and 2) patients who received usual
care (control group) (n=107). The relationship between the stroke-associated pneumonia
incidence and prognosis was examined.
Results
The early intervention group had a significantly lower incidence of stroke-associated
pneumonia than the control group (0.93% vs. 7.48%; P=0.01). Moreover, the early intervention
group had a significantly lower proportion of patients who died or required medical
care because of recurrent pneumonia at discharge (0.93% vs. 5.6%; P=0.04). In contrast,
there were no significant differences between the two groups regarding the Revised
Hasegawa's Dementia Scale on day 14 (22.5 vs. 23; P=0.87), Functional Independence
Measure on day 14 (112 vs. 116; P=0.06), and rate of total oral diet (Food Intake
LEVEL Scale ≥7) at discharge (95.2% vs. 93.5%; P=0.55).
Conclusions
Combined early oral healthcare and early mobilisation by a multidisciplinary team
significantly decreased the stroke-associated pneumonia incidence within 7 days and
reduced the percentage of patients who died or required medical care because of recurrent
pneumonia after stroke.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of Stroke and Cerebrovascular DiseasesAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Factors influencing in-hospital mortality and morbidity in patients treated on a stroke unit.Neurology. 2011; 77: 965-972
- The impact of pneumonia on hospital stay among patients hospitalized for acute stroke.Neurosciences (Riyadh). 2014; 19: 118-123
- Diagnosis of stroke-associated pneumonia: Recommendations from the pneumonia in stroke consensus group.Stroke. 2015; 46: 2335-2340
- How is pneumonia diagnosed in clinical stroke research? A systematic review and meta-analysis.Stroke. 2015; 46: 1202-1209
- Stroke-associated pneumonia: major advances and obstacles.Cerebrovasc Dis. 2013; 35: 430-443
- Complications following acute ischemic stroke.Eur Neurol. 2002; 48: 133-140
- Derivation and validation of a clinical system for predicting pneumonia in acute stroke.Neuroepidemiology. 2010; 34: 193-199
- Dysphagia screening decreases pneumonia in acute stroke patients admitted to the stroke intensive care unit.J Neurol Sci. 2011; 306: 38-41
- Development of a clinical score (A2DS2) to predict pneumonia in acute ischemic stroke.Stroke. 2012; 43: 2617-2623
- Factors associated with risk of stroke-associated pneumonia in patients with dysphagia: A systematic Review.Dysphagia. 2020; 35: 735-744
- Oral care after stroke: Where are we now?.Eur Stroke J. 2018; 3: 347-354
- Prophylactic antibiotics after acute stroke for reducing pneumonia in patients with dysphagia (STROKE-INF): a prospective, cluster-randomised, open-label, masked endpoint, controlled clinical trial.Lancet. 2015; 386: 1835-1844
- Update on management options for dysphagia after acute stroke.Br J Neurosci Nurs. 2015; 11: 10-19
- Safety and effect of metoclopramide to prevent pneumonia in patients with stroke fed via nasogastric tubes trial.Stroke. 2015; 46: 454-460
- Reduction in the incidence of poststroke nosocomial pneumonia by using the "turn-mob" program.J Stroke Cerebrovasc Dis. 2010; 19: 23-28
- Association between out-of-bed mobilization and complications of immobility in acute phase of severe stroke: A retrospective observational study.J Stroke Cerebrovasc Dis. 2020; 29105112
- Impact of dysphagia assessment and management on risk of stroke-associated pneumonia: a systematic review.Cerebrovasc Dis. 2018; 46: 99-107
- Improving post-stroke dysphagia outcomes through a standardized and multidisciplinary protocol: an exploratory cohort study.Dysphagia. 2014; 29: 704-712
- The multidisciplinary swallowing team approach decreases pneumonia onset in acute stroke patients.PLoS One. 2016; 11e0154608
- Behavioural intervention for dysphagia in acute stroke: a randomised controlled trial.Lancet Neurol. 2006; 5: 31-37
- Meteorological factors and seasonal stroke rates: a four-year comprehensive study.J Stroke Cerebrovasc Dis. 2019; 28: 2324-2331
- The revised Hasegawa's Dementia Scale (HDS-R)-evaluation of its usefulness as a screening test for dementia.J.H.K.C. Psych. 1994; 4: 20-24
- Reliability and validity of a tool to measure the severity of dysphagia: the Food Intake LEVEL Scale.J Pain Symptom Manag. 2013; 46: 201-206
- Oral care reduces pneumonia in older patients in nursing homes.J Am Geriatr Soc. 2002; 50: 430-433
- Interventions for improving oral health in people after stroke.Cochrane Database Syst Rev. 2020; 12CD003864
- Sitting position improves consciousness level in patients with cerebral disorders.Open J Ther Rehabil. 2013; 1: 1-3
Article info
Publication history
Published online: November 14, 2022
Accepted:
November 9,
2022
Received in revised form:
October 26,
2022
Received:
August 28,
2022
Footnotes
Grant support: None
Identification
DOI: https://doi.org/10.1016/j.jstrokecerebrovasdis.2022.106893
Copyright
© 2022 Elsevier Inc. All rights reserved.
