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The effects of combined early oral health care and early mobilisation on the incidence of stroke-associated pneumonia

      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

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      References

        • Koennecke HC
        • Belz W
        • Berfelde D
        • et al.
        Factors influencing in-hospital mortality and morbidity in patients treated on a stroke unit.
        Neurology. 2011; 77: 965-972
        • Bijani B
        • Mozhdehipanah H
        • Jahanihashemi H
        • et al.
        The impact of pneumonia on hospital stay among patients hospitalized for acute stroke.
        Neurosciences (Riyadh). 2014; 19: 118-123
        • Smith CJ
        • Kishore AK
        • Vail A
        • et al.
        Diagnosis of stroke-associated pneumonia: Recommendations from the pneumonia in stroke consensus group.
        Stroke. 2015; 46: 2335-2340
        • Kishore AK
        • Vail A
        • Chamorro A
        • et al.
        How is pneumonia diagnosed in clinical stroke research? A systematic review and meta-analysis.
        Stroke. 2015; 46: 1202-1209
        • Hannawi Y
        • Hannawi B
        • Rao CP
        • et al.
        Stroke-associated pneumonia: major advances and obstacles.
        Cerebrovasc Dis. 2013; 35: 430-443
        • Weimar C
        • Roth MP
        • Zillessen G
        • et al.
        Complications following acute ischemic stroke.
        Eur Neurol. 2002; 48: 133-140
        • Chumbler NR
        • Williams LS
        • Wells CK
        • et al.
        Derivation and validation of a clinical system for predicting pneumonia in acute stroke.
        Neuroepidemiology. 2010; 34: 193-199
        • Yeh SJ
        • Huang KY
        • Wang TG
        • et al.
        Dysphagia screening decreases pneumonia in acute stroke patients admitted to the stroke intensive care unit.
        J Neurol Sci. 2011; 306: 38-41
        • Hoffmann S
        • Malzahn U
        • Harms H
        • et al.
        Development of a clinical score (A2DS2) to predict pneumonia in acute ischemic stroke.
        Stroke. 2012; 43: 2617-2623
        • Eltringham SA
        • Kilner K
        • Gee M
        • et al.
        Factors associated with risk of stroke-associated pneumonia in patients with dysphagia: A systematic Review.
        Dysphagia. 2020; 35: 735-744
        • Lyons M
        • Smith C
        • Boaden E
        • et al.
        Oral care after stroke: Where are we now?.
        Eur Stroke J. 2018; 3: 347-354
        • Kalra L
        • Irshad S
        • Hodsoll J
        • et al.
        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
        • Beavan JR.
        Update on management options for dysphagia after acute stroke.
        Br J Neurosci Nurs. 2015; 11: 10-19
        • Warusevitane A
        • Karunatilake D
        • Sim J
        • et al.
        Safety and effect of metoclopramide to prevent pneumonia in patients with stroke fed via nasogastric tubes trial.
        Stroke. 2015; 46: 454-460
        • Cuesy PG
        • Sotomayor PL
        • Piña JOT.
        Reduction in the incidence of poststroke nosocomial pneumonia by using the "turn-mob" program.
        J Stroke Cerebrovasc Dis. 2010; 19: 23-28
        • Naito Y
        • Kamiya M
        • Morishima N
        • et al.
        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
        • Eltringham SA
        • Kilner K
        • Gee M
        • et al.
        Impact of dysphagia assessment and management on risk of stroke-associated pneumonia: a systematic review.
        Cerebrovasc Dis. 2018; 46: 99-107
        • Gandolfi M
        • Smania N
        • Bisoffi G
        • et al.
        Improving post-stroke dysphagia outcomes through a standardized and multidisciplinary protocol: an exploratory cohort study.
        Dysphagia. 2014; 29: 704-712
        • Aoki S
        • Hosomi N
        • Hirayama J
        • et al.
        The multidisciplinary swallowing team approach decreases pneumonia onset in acute stroke patients.
        PLoS One. 2016; 11e0154608
        • Carnaby G
        • Hankey GJ
        • Pizzi J.
        Behavioural intervention for dysphagia in acute stroke: a randomised controlled trial.
        Lancet Neurol. 2006; 5: 31-37
        • Salam A
        • Kamran S
        • Bibi R
        • et al.
        Meteorological factors and seasonal stroke rates: a four-year comprehensive study.
        J Stroke Cerebrovasc Dis. 2019; 28: 2324-2331
        • Imai Y
        • Hasegawa K.
        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
        • Kunieda K
        • Ohno T
        • Fujishima I
        • et al.
        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
        • Yoneyama T
        • Yoshida M
        • Ohrui T
        • et al.
        Oral care reduces pneumonia in older patients in nursing homes.
        J Am Geriatr Soc. 2002; 50: 430-433
        • Campbell P
        • Bain B
        • Lc Furlanetto D
        • et al.
        Interventions for improving oral health in people after stroke.
        Cochrane Database Syst Rev. 2020; 12CD003864
        • Moriki T
        • Nakamura T
        • Kojima D
        • et al.
        Sitting position improves consciousness level in patients with cerebral disorders.
        Open J Ther Rehabil. 2013; 1: 1-3