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CHOSEN: A Randomized Controlled Feasibility Trial.

Craig J Smith1,2, Andrew Brand3, Zoe Hoare3

  • 1Division of Cardiovascular Sciences University of Manchester Manchester UK.

Journal of the American Heart Association
|September 11, 2025
PubMed
Summary
This summary is machine-generated.

Oral health care (OHC) interventions, including chlorhexidine and powered brushing, are feasible and safe for stroke patients with dysphagia. Staff training enhances OHC delivery, paving the way for definitive trials on efficacy and cost-effectiveness.

Keywords:
chlorhexidineoral health carepoststroke pneumoniarandomized trialstroke, acute

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Area of Science:

  • Stroke care research
  • Infection prevention in healthcare settings
  • Oral hygiene interventions

Background:

  • Acutely dysphagic stroke patients are at high risk for pneumonia.
  • Improving oral health care (OHC) is a potential strategy to prevent pneumonia in this population.
  • A phase 3 trial assessing OHC feasibility in stroke units was warranted.

Purpose of the Study:

  • To determine the feasibility and safety of different oral health care (OHC) treatments in acute stroke patients with dysphagia.
  • To evaluate the impact of staff education and training on OHC delivery.
  • To establish criteria for a definitive trial on OHC efficacy and cost-effectiveness.

Main Methods:

  • The CHOSEN trial, a feasibility study, randomized 101 acute stroke patients with dysphagia to 4 OHC groups (manual/powered toothbrush with toothpaste/chlorhexidine gel).
  • Standardized staff education and training were provided.
  • Feasibility was assessed using pre-defined criteria, with adherence and follow-up rates monitored.

Main Results:

  • Recruitment reached 77% of eligible patients, with 91% adherence and 88% follow-up completion.
  • No significant differences in serious adverse events were observed between OHC groups.
  • Exploratory analyses showed no substantial differences in pneumonia, survival, or functional outcomes at 3 months.

Conclusions:

  • Oral health care interventions, including chlorhexidine and powered brushing, are feasible and safe in acutely dysphagic stroke patients.
  • Standardized staff training is a crucial component for successful OHC implementation.
  • The study met progression criteria for a definitive trial evaluating OHC efficacy and cost-effectiveness.