•  
  •  
 

Abstract

Background: Despite being a common problem, long-term disability following stroke often improves after survivors receive regular rehabilitative therapy. This study aimed to assess the oral health-related quality of life (OHRQoL) of stroke survivors who had access to a community-based rehabilitation centre after hospital discharge.

Methods: Dentate post-stroke patients receiving regular rehabilitative care with slight to moderate dependency (Barthel Index >70) and without severe cognitive impairment were involved in this study. The OHRQoL parameters were measured using the Oral Health Impact Profile-14 (OHIP-14) and EuroQol five dimensions (EQ-5D-5L) questionnaires.

Results: Thirty one patients were recruited in this study. Majority of the patients hardly ever or never had problems in all functional, physical, psychological and social domains, including eating discomfort and having to avoid eating, difficulty in chewing food and presumably having bad breath (58.1%, 61.3% and 71.0% respectively). Other than gender, age, ethnicity, co-morbidities and oral hygiene practices, education level was the only variable found to significantly affect patients’ OHRQoL (p = 0.028). Most of the patients had no or slight problem(s) in self-care (87.1%) and carrying out usual activities (57.1%), pain/discomfort (3.2%) and anxiety/depression (6.5%).

Conclusion: Stroke survivors under regular rehabilitative care perceived have good oral health-related quality of life.

References

1. Loo KW, Gan SH. Burden of stroke in Malaysia. Int J Stroke Off J Int Stroke Soc. 2012;7:165–7.

2. Farzadfard MT, Sheikh Andalibi MS, Thrift AG, Morovatdar N, Stranges S, Amiri A, et al. Long-term disability after stroke in Iran: evidence from the Mashhad Stroke Incidence Study. Int J Stroke Off J Int Stroke Soc. 2019;14:44–7.

3. Aziz ZA, Lee YY, Ngah BA, Sidek NN, Looi I, Hanip MR, et al. Acute stroke registry Malaysia, 2010-2014: Results from the National Neurology Registry. J Stroke Cerebrovasc Dis Off J Natl Stroke Assoc. 2015;24:2701–9.

4. Mohd Nordin NA, Aziz NA, Abdul Aziz AF, Ajit Singh DK, Omar Othman NA, Sulong S, et al. Exploring views on long term rehabilitation for people with stroke in a developing country: findings from focus group discussions. BMC Health Serv Res. 2014;14:118.

5. Abdul Aziz AF, Mohd Nordin NA, Ali MF, Abd Aziz NA, Sulong S, Aljunid SM. The integrated care pathway for post stroke patients (iCaPPS): a shared care approach between stakeholders in areas with limited access to specialist stroke care services. BMC Health Serv Res. 2017;17:35.

6. Locker D, Clarke M, Payne B. Self-perceived oral health status, psychological well-being, and life satisfaction in an older adult population. J Dent Res. 2000;79:970–5.

7. Kwok C, McIntyre A, Janzen S, Mays R, Teasell R. Oral care post stroke: a scoping review. J Oral Rehabil. 2015;42:65–74.

8. McMillan AS, Leung KC, Pow EH, Wong MC, Li LS, Allen PF. Oral health-related quality of life of stroke survivors on discharge from hospital after rehabilitation. J Oral Rehabil. 2005;32:495–503.

9. Jang EJ, Kim EK, Lee KS, Lee HK, Choi YH, Hwang TY, et al. Oral health related quality of life and it's related factors of stroke patients at home in Korea. Arch Gerontol Geriatr. 2015;61:523–8.

10. Zhu HW, McGrath C, McMillan AS, Li LS. Can caregivers be used in assessing oral health-related quality of life among patients hospitalized for acute medical conditions? Commun Dent Oral Epidemiol. 2008;36:27–33.

11. Hunter RV, Clarkson JE, Fraser HW, MacWalter RS. A preliminary investigation into tooth care, dental attendance and oral health related quality of life in adult stroke survivors in Tayside, Scotland. Gerodontology. 2006;23:140–8.

12. Cameron JI, O'Connell C, Foley N, Salter K, Booth R, Boyle R, et al. Canadian stroke best practice recommendations: managing transitions of care following stroke, Guidelines Update 2016. Int J Stroke Off J Int Stroke Soc. 2016;11:807–22.

13. Aziz AF, Aziz NA, Nordin NA, Ali MF, Sulong S, Aljunid SM. What is next after transfer of care from hospital to home for stroke patients? Evaluation of a community stroke care service based in a primary care clinic. J Neurosci Rural Pract. 2013;4:413–20.

14. Dai R, Lam OLT, Lo ECM, Li LSW, McGrath C. Oral health-related quality of life in patients with stroke: a randomized clinical trial of oral hygiene care during outpatient rehabilitation. Sci Rep. 2017;7:7632.

15. Abdullah NS, Radzali NFM, Saub R, Vaithilingam RD. Oral health related quality of life and periodontal status of a selected Malaysian adult population: A pilot study. Ann Dent. 2013:16–23.

16. Mahoney FI, Barthel DW. Functional evaluation: the Barthel Index. Md State Med J. 1965;14:61–5.

17. Lam OL, McMillan AS, Li LS, McGrath C. Predictors of oral health-related quality of life in patients following stroke. J Rehabil Med. 2014;46:520–6.

18. Herdman M, Gudex C, Lloyd A, Janssen M, Kind P, Parkin D, et al. Development and preliminary testing of the new five-level version of EQ-5D (EQ-5D-5L). Qual Life Res Int J Qual Life Aspects Treat Care Rehabil. 2011;20:1727–36.

19. Saub R, Locker D, Allison P. Derivation and validation of the short version of the Malaysian Oral Health Impact Profile. Commun Dent Oral Epidemiol. 2005;33:378–83.

20. Baiju RM, Peter E, Varghese NO, Sivaram R. Oral health and quality of life: current concepts. J Clin Diagn Res. 2017;11:ZE21–6.

21. Richardson M, Campbell N, Allen L, Meyer M, Teasell R. The stroke impact scale: performance as a quality of life measure in a community-based stroke rehabilitation setting. Disabil Rehabil. 2016;38:1425–30.

22. Nor Azlin MN, Aziz NA, Saperi BS, Aljunid SM. Functional limitation and health-related quality of life, and associated factors among long term stroke survivors in a Malaysian community. Med J Malaysia. 2016;71:313–21.

23. Chien SH, Sung PY, Liao WL, Tsai SW. A functional recovery profile for patients with stroke following post-acute rehabilitation care in Taiwan. J Formos Med Assoc. 2020;119:254–9.

24. Lam KH, Blom E, Kwa VIH. Predictors of quality of life 1 year after minor stroke or TIA: a prospective single-centre cohort study. BMJ Open. 2019;9:e029697.

25. Visser MM, Heijenbrok-Kal MH, Spijker AV, Oostra KM, Busschbach JJ, Ribbers GM. Coping, problem solving, depression, and health-related quality of life in patients receiving outpatient stroke rehabilitation. Arch Phys Med Rehabil. 2015;96:1492–8.

26. Visser MM, Aben L, Heijenbrok-Kal MH, Busschbach JJ, Ribbers GM. The relative effect of coping strategy and depression on health-related quality of life in patients in the chronic phase after stroke. J Rehabil Med. 2014;46:514–9.

27. Chen Q, Cao C, Gong L, Zhang Y. Health related quality of life in stroke patients and risk factors associated with patients for return to work. Medicine. 2019;98:e15130.

28. Ramos-Lima MJM, Brasileiro IC, Lima TL, Braga-Neto P. Quality of life after stroke: impact of clinical and sociodemographic factors. Clinics. 2018;73:e418.

29. Yen YY, Lee HE, Wu YM, Lan SJ, Wang WC, Du JK, et al. Impact of removable dentures on oral health-related quality of life among elderly adults in Taiwan. BMC Oral Health. 2015;15:1.

30. Ayala-Luis J, Johansson V, Sampogna F, Axtelius B, Söderfeldt B. A multivariable analysis of patient dental satisfaction and oral health-related quality-of-life. A cross-sectional study based on DVSS and OHIP-14. Acta Odontol Scand. 2014;72:187–93.

31. Kim HT, Park JB, Lee WC, Kim YJ, Lee Y. Differences in the oral health status and oral hygiene practices according to the extent of post-stroke sequelae. J Oral Rehabil. 2018;45:476–84.

32. Schimmel M, Ono T, Lam OL, Müller F. Oro-facial impairment in stroke patients. J Oral Rehabil. 2017;44:313–26.

33. Abdul Aziz AF, Mohd Nordin NA, Abd Aziz N, Abdullah S, Sulong S, Aljunid SM. Care for post-stroke patients at Malaysian public health centres: self-reported practices of family medicine specialists. BMC Fam Pract. 2014;15:40.

34. Ab Malik N, Abdul Razak F, Mohamad Yatim S, Lam OLT, Jin L, Li LSW, et al. Oral health interventions using Chlorhexidine-Effects on the prevalence of oral opportunistic pathogens in stroke survivors: a randomized clinical trial. J Evid Based Dent Pract. 2018;18:99–109.

Share

COinS
 
 

To view the content in your browser, please download Adobe Reader or, alternately,
you may Download the file to your hard drive.

NOTE: The latest versions of Adobe Reader do not support viewing PDF files within Firefox on Mac OS and if you are using a modern (Intel) Mac, there is no official plugin for viewing PDF files within the browser window.