Effect of structured oral care on the oral health-related outcomes of stroke patients in stroke care settings: a systematic review

Abstract

Background: Stroke patients often depend on caregivers for effective oral care. There are no consensus on the recommended oral care for stroke patients but structured oral care by caregivers may improve their oral health-related outcomes. Aim: To investigate the effect of structured oral care provided by caregivers on stroke patients’ oral health, oral health-related quality of life and pneumonia in stroke care settings. Methods: English publications were searched on six databases (CENTRAL, PubMed, Embase, CINAHL, Scopus and Web of Science) from inception to 6 February 2021. ProQuest Theses and Dissertations, ClinicalTrials.gov and WHO ICTRP, reference lists and specialised journals were examined. We included randomised, quasi-experimental, non-randomised controlled studies and controlled before-after trials examining the impact of structured oral care by caregivers on stroke patients’ oral health, oral health-related quality of life and pneumonia in stroke care settings. Two reviewers independently extracted data using standardised forms and assessed the quality of studies with RoB, ROBINS-i and GRADE. Narrative synthesis by vote- counting using direction of effect were conducted instead of meta-analyses, heterogeneity tests, sensitivity tests and subgroup analyses. Results: We included one cluster-randomised trial, three randomised trial and one controlled- before-after study involving 522 participants. One study assessed but did not report the oral health-related quality of life. One out of two and two out of three studies favoured the intervention group for oral health and pneumonia respectively. Conclusion: No conclusions about the effect of structured oral care could be made due to very low certainty of evidence for pneumonia and oral health. Implications: Adequately-powered randomised trials with detailed descriptions of intervention and comparators as well as feasible strategies to assess implementation fidelity are needed. No specific policy and practice recommendations could be made as studies did not provide evidence of effectiveness.