Oral hygiene interventions for people with intellectual disabilities

Waldron, Catherine; Nunn, June; Phadraig, Caoimhin Mac Giolla; Comiskey, Catherine; Guérin, Suzanne; Harten, Maria Van; Donnelly‐Swift, Erica; Clarke, Mike

doi:10.1002/14651858.cd012628.pub2

Cited by 75 publications

(83 citation statements)

References 95 publications

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“…This realist review followed a published protocol and followed the RAMESES publication standards for realist reviews 10 . It was undertaken alongside a Cochrane Review, reported separately 6 . It was anticipated that the parallel use of methods would identify which interventions work (Cochrane) for whom and under what circumstances (realist), thereby generating a uniquely comprehensive understanding of what should be implemented, and how, in different settings 11,12 …”

Section: Methodsmentioning

confidence: 99%

“…Thus, our starting point was the search strategy and criteria for the Cochrane Review, which included 178 randomized controlled trials and nonrandomized studies. 6 Of these, we excluded 41 published in languages other than English. We further refined by filtering for studies that provided contexts, mechanisms and outcomes that were relevant to carer‐led interventions.…”

Section: Methodsmentioning

confidence: 99%

“…The effectiveness of such interventions has recently been systematically examined in a Cochrane Review which found that while some interventions showed benefits in one setting, they did not in another. The conclusion was that the reviewed studies demonstrated little long‐term impact on the oral health of the target population 6 …”

Section: Introductionmentioning

confidence: 99%

“…Although the Cochrane Review did not find any evidence that the level of intellectual disability of the participants in the studies had any impact on the outcomes, the extensive involvement of carers in oral hygiene routines was implicit, especially for people with moderate, severe or profound levels of intellectual disabilities; these carers have to take on a fuller role in achieving and maintaining oral health. The impact of the level of care the carers provided, on the oral health of the people for whom they care and the challenges for carers when encountering resistance to care, was evidenced, and was identified by the review team as an important area for further review 6 …”

Section: Introductionmentioning

confidence: 99%

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What is it about carer‐led oral hygiene interventions for people with intellectual disabilities that work and why? A realist review

Waldron

Phadraig

Nunn

2020

Comm Dent Oral Epid

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Objectives To undertake a realist review of carer‐led oral hygiene interventions for people with intellectual disabilities. This was run parallel with a Cochrane Review. Methods Realist review methods were followed. This was characterized by an iterative process of developing and refining theories of how interventions might work, expressed as context‐mechanism‐outcome configurations. The steps included identifying candidate theories with local and international expert consultation before applying an iterative search strategy. Selection criteria were applied for screening of the abstracts and 10% of the included full texts were screened by the three review members, independently, to ensure adherence to the criteria. Data were extracted in NVivo and synthesized qualitatively to confirm, refute or refine theories about what works, why, in what circumstances and for whom. Results Of the 697 potential sources, 112 studies progressed to full‐text screening, and 58 of those were included in the review. These 58 studies found evidence to support six theories about carer‐led oral hygiene interventions for people with intellectual disabilities, from a starting point of ten candidate theories. This realist review found evidence to support the contention that, in order for carer‐led oral hygiene interventions for people with ID to succeed, there is a need for adequate resources and a system‐level approach; involving carers in design and implementation; tailoring of training to suit carers’ needs and work environments; clearly stating how interventions are expected to work; specifying goals with achievable steps for carers to follow; providing carers with support and feedback on their efforts; acknowledging the physical and emotional toll caring for people with intellectual disabilities has on the well‐being of carers; and repeating training. Conclusions The theories from this realist review will direct future interventions by suggesting the mechanisms and contexts that are important to achieve the intended outcome of improved oral health for people with intellectual disabilities. These are, of course, propositions intended for testing, rather than proven. The parallel use of Cochrane and realist methods provides a unique richness to our hypothesis of what works, for whom, when and how.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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What is it about carer‐led oral hygiene interventions for people with intellectual disabilities that work and why? A realist review

Waldron

Phadraig

Nunn

2020

Comm Dent Oral Epid

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“…Statistical analyses of pooled data from comparable randomised controlled trials and some non-randomised studies (eg controlled before/after; interrupted time-series; repeated measures) are more likely than most other reviews to synthesise robust evidence on the effects of illnesses and therapies and the phenomena influencing them. 2,37,49,50 However, the credibility of the analysis towards evaluating specific interventions or establishing broad generalisations depends on the homogeneity of data from the primary trials or studies, and on the efforts of reviewers to conduct a comprehensive, transparent, unbiased, appropriately weighted and reproducible literature review. 2,8,51 Observational studies associated with side effects or rare events have also been reviewed systematically as complementary to evidence from randomised controlled trials.…”

Section: Meta-analysismentioning

confidence: 99%

A typology of systematic reviews for synthesising evidence on health care

MacEntee

2019

Gerodontology

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Objectives The objectives of this paper are to (a) Review published references to systematic reviews; (b) offer a typology of systematic reviews for synthesising evidence on health care; and (c) summarise the guides for designing, reporting and appraising the reviews. Background Systematic reviews play a role in finding, synthesising, transferring and implementing evidence for healthcare policy, practice guidelines and allocation of health resources. They have been particularly successful in confirming or synthesising evidence for health care by meta‐analysing aggregated data from multiple randomised controlled trials. However, concerns about the limitations of evidence from controlled trials have prompted interest in other review methods capable of locating and appraising evidence from more diverse, and possibly more realistic, healthcare situations. Methods An iterative citation‐tracking process with Google Search and grey literature identified 204 papers on previous typologies and methods of systematic reviews. Results and Conclusions There are six types of systematic reviews: narrative; meta‐analysis; scoping; qualitative; umbrella; and realist. Each type has distinct objectives, characteristics and attributes, but with much overlapping of methods and guides. Sensitivity to the need for qualitative evidence on complex human responses to ill‐health and health care has broadened the objectives and methods of health‐related systematic reviews to find, appraise and synthesis useful evidence for practice guidelines, healthcare policy and allocation of health resources.

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