# Effects of a Standardised Medical–Dental Collaborative Protocol on Acute Stroke Rehabilitation: A Multicentre Prospective Cohort Study

## TL;DR

A new protocol for oral care in stroke patients improved oral hygiene and reduced hospital stays, but did not prevent aspiration pneumonia.

## Contribution

A standardized medical-dental protocol was developed and tested for acute stroke rehabilitation outcomes.

## Key findings

- The protocol group showed significant improvements in oral hygiene and tongue mobility.
- Hospital stay duration was significantly reduced in the protocol group.
- Aspiration pneumonia rates were not significantly different between groups.

## Abstract

Acute stroke often causes complications such as aspiration pneumonia, which can be prevented through oral hygiene. However, evidence supporting individualised oral care remains limited. We developed a multidisciplinary oral function management protocol and evaluated its benefits in patients with acute stroke, including its impact on aspiration pneumonia.

In this prospective multicentre cohort study, data from 1616 patients with acute stroke admitted to participating hospitals between 31 July 2017, and 27 January 2021 were analysed. Hospitals implemented our oral function management program (Protocol group) or provided conventional oral care (control group). To minimise confounding by baseline severity, propensity scores were estimated using stroke severity and initial complications; patients were matched 1:1 using nearest‐neighbour matching with a calliper of 0.2, resulting in 313 matched pairs (n = 626). Primary outcome was the incidence of aspiration pneumonia; secondary outcomes were hospital stay length and oral function improvement.

No significant differences in aspiration pneumonia onset rates were detected between the protocol and control groups (p = 0.7639). Compared to controls, the protocol group showed significant improvements in oral hygiene (p < 0.0001), tongue mobility (p = 0.0292), and FOIS scores (p = 0.0005). Time from admission to discharge evaluation (p < 0.0001) and total length of hospital stay (p = 0.0018) were significantly reduced. Compared to administration of conventional oral care, implementation of this Protocol facilitated earlier oral management and feeding/swallowing rehabilitation, potentially reducing hospital stays and enhancing oral functions.

The protocol may enhance oral functionality and reduce hospitalisation duration by systematising multidisciplinary oral management and swallowing rehabilitation, alongside supporting conventional pneumonia prevention strategies.

Effects of a standardised medical–dental collaborative protocol on acute stroke rehabilitation: A multicentre prospective cohort study.