SOCLE II: Stroke Oral healthCare pLan Evaluation
Study Details
Study Description
Brief Summary
Stroke associated pneumonia (SAP) affects a fifth of stroke survivors annually, tripling the risk of death at 30 days and contributing to poorer rehabilitation outcomes, prolonged hospital stays and dependency at discharge. Systematic review evidence indicates that enhanced oral health care (OHC) has a preventative effect on the incidence of pneumonia amongst nursing home populations (absolute risk reductions 6.6% to 11.7%; numbers needed to treat 8.6 to 15.3 individuals). There are strong theoretical reasons to suggest similar benefits might be observed in stroke care settings but current empirical evidence is weak - trial quality (randomisation, blinding, sample size, reporting), intervention description and thus feasibility of translation into clinical practice is very poor. Following an extensive pre-clinical programme of work, investigators now plan the pilot phase (Phase II) of a stepped-wedge cluster RCT of a well-developed and defined complex OHC intervention versus usual OHC. Investigators aim to establish a robust web-based randomisation process, refine the proposed intervention (training, tools, equipment), recruitment, adherence, record linkage and sampling methodologies. Investigators also aim to establish the relationship between SAP and plaque and any diversity between sites.
| Condition or Disease | Intervention/Treatment | Phase |
|---|---|---|
|
Phase 2 |
Detailed Description
SOCLE II is the pilot phase (Phase II) of a stepped-wedge cluster randomised controlled trial (RCT) of a complex oral health care (OHC) intervention versus usual OHC.
SOCLE II aims to evaluate the feasibility of a full scale pragmatic trial of the clinical and cost effectiveness of a complex OHC package of care versus usual care for people in stroke care settings. Ward level cluster randomisation will progress in a stepped wedge manner where after a period of baseline data collection each ward in a randomly allocated order will 'convert' from usual care to an enhanced oral health care intervention.
This pilot trial will assess the feasibility of delivering this enhanced OHC intervention across four sites and will inform the trial design of a full scale phase III trial including refining the proposed intervention (training, tools, equipment), recruitment, adherence, record linkage, sampling methodologies, sample size calculations and pilot our health economic evaluation. Investigators also aim to establish the relationship between SAP and plaque and any diversity between sites. Our proposed pilot work will support an application for a planned Phase III definitive trial.
Principal Research Questions:
(i) Are the SOCLE intervention and data collection process viable across multiple sites? (ii) Can sample size calculations and estimates of recruitment and retention be refined? (iii) Can pneumonia event rates across several sites and distribution over time post stroke onset be determined? (iv) Can the association between dental and denture plaque and SAP be established? (v) Can the predetermined criteria for progression to Phase III definitive multi-centred stepped wedge cluster RCT with economic evaluation be met?
Study Design
Arms and Interventions
| Arm | Intervention/Treatment |
|---|---|
| Experimental: Enhanced complex oral health care intervention The complex oral health care (OHC) intervention (SOCLE intervention) includes patient, staff and service level interventions. |
Other: Enhanced complex oral health care
Our proposed complex oral health care (OHC) intervention (SOCLE intervention) comprises 3 levels of intervention:
Patient Level: An individualised OHC assessment on admission and individualised OHC plans for patients, which may involve staff-led OHC support, access to OHC equipment, products and specialist support services and OHC health promotion components.
Staff Level: Specialist web-based OHC educational training, including information on the oral cavity and structures; oral health problems (e.g. decay, gum disease, dry mouth); instruction on OHC techniques, equipment and products; use of the SOCLE assessment and protocol tools.
Service Level: Processes to facilitate access to specialist dental support services (e.g. dentist, hygienist, denture repair laboratory). Essential OHC equipment (toothbrushes, denture marking kits) and products (e.g. toothpaste, oral balance gel) on the ward will be available.
|
| No Intervention: Usual oral health care Oral health care (OHC) will be provided in the standard manner, with no change to usual care. Provision of this standard OHC will be sampled monthly. Surveys suggest that standard oral health care (OHC) in stroke care settings comprise poorly supported OHC interventions delivered by staff that lacked access to specialist training, products, equipment, assessments, protocols and dental services. |
Outcome Measures
Primary Outcome Measures
- Pneumonia [Weekly assessments for the duration of ward stay until discharge, an expected average stay of no more than 3 weeks.]
Based on the Mann Criteria for Chest infection and evaluated based on concurrent review of case notes at each weekly data collection point and a retrospective review of case notes on discharge.
Secondary Outcome Measures
- Oral Health Impact Profile [Weekly assessments for the duration of ward stay until discharge, an expected average stay of no more than 3 weeks.]
Patient rated Oral Health Impact Profile (with activity and participation components, Locker et al 2002)
- Dental plaque [Weekly assessments for the duration of ward stay until discharge, an expected average stay of no more than 3 weeks.]
- Denture plaque [Weekly assessments for the duration of ward stay until discharge, an expected average stay of no more than 3 weeks.]
- Antibiotics prescribed [Weekly for the duration of ward stay until discharge, an expected average stay of no more than 3 weeks.]
The prescription of antibiotics and type of antibiotic prescription will be documented from the drug kardex.
- Death [Participants will be followed for the duration of hospital stay, an expected average stay of no more than 3 weeks.]
Other Outcome Measures
- Length of hospital stay [Determined at point of discharge from hospital ward (expected average stay of no more than 3 weeks).]
- Discharge destination [Determined at point of discharge from hospital ward (expected average stay of no more than 3 weeks).]
- Knowledge and attitudes of staff [1. Prior to OHC training package (3 to 10 months after start of recruitment depending on randomised allocation). 2. After completion of training package. 3. At close of study (16 months after recruitment starts at the initial site).]
In this stepped-wedge randomised controlled trial design staff will be asked to complete knowledge and attitudes questionnaires (Frenkel 2001) at the 3 stated time points. (Ref: Frenkel HF et al. Improving oral health of institutionalised elderly people by educating caregivers. Community Dent Oral Epidemiol 2001;29:289-97)
- Adherence [Weekly assessments for the duration of study (16 months).]
Adherence to study protocol - including completed assessments, documented oral health care plans
- OHC resource use [Weekly assessments for the duration of study (16 months).]
Oral health care equipment and product resource use questionnaire, and specialist services resource use questionnaire
Eligibility Criteria
Criteria
Inclusion Criteria:
- All patients admitted to stroke care settings.
Exclusion Criteria:
- Consent declined.
Contacts and Locations
Locations
| Site | City | State | Country | Postal Code | |
|---|---|---|---|---|---|
| 1 | Hairmyres Hospital | East Kilbride | Lanarkshire | United Kingdom | G75 8RG |
| 2 | Wishaw General Hospital | Wishaw | Lanarkshire | United Kingdom | ML2 0DP |
| 3 | Stobhill Hospital | Glasgow | Scotland | United Kingdom | G21 3UW |
| 4 | Royal Alexandra Hospital | Paisley | Scotland | United Kingdom | PA2 9PN |
Sponsors and Collaborators
- Glasgow Caledonian University
- Nursing Midwifery and Allied Health Profession (NMAHP) Research Unit
- University of Glasgow
- NHS Lanarkshire
- Glasgow Dental Hospital and School
- University of Edinburgh
Investigators
- Principal Investigator: Marian Brady, Glasgow Caledonian University
Study Documents (Full-Text)
None provided.More Information
Publications
None provided.- TSA 2012/09