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Article ; Online: Occupational therapists' assessment and reporting of functional cognition in stroke care.

Ward, Jana / Foley, Geraldine / Horgan, Frances

2024 , Page(s) 1–10

Abstract: Purpose: To investigate how functional cognition of people post-stroke is evaluated and reported by occupational therapists in Ireland. Functional cognition refers to the use and integration of cognitive skills for daily function.: Methods: This ... ...

Abstract	Purpose: To investigate how functional cognition of people post-stroke is evaluated and reported by occupational therapists in Ireland. Functional cognition refers to the use and integration of cognitive skills for daily function. Methods: This study used a qualitative design. Six focus groups and one individual interview were conducted with 20 occupational therapists purposively sampled for variation across different clinical grades. Data were analysed according to the Braun and Clark thematic analysis framework. Results: Participants felt that assessment of functional cognition was an integral feature of occupational therapy assessment in stroke care but acknowledged that terminology used by occupational therapists for functional cognition was inconsistent. Non-standardised observational assessment was routinely used by participants. Challenges were reported with respect to written documentation of non-standardised observations. Participants reported that use of standardised cognitive assessments required considered clinical reasoning before administration. Standardised performance-based assessments were not widely implemented by participants. Conclusion: Occupational therapists in Ireland reported a multi-component assessment process to evaluate functional cognition post-stroke. Establishing practice guidelines for the assessment of functional cognition may be of benefit to occupational therapists working in stroke care. Further research is needed to quantify procedures in this assessment process to account for variation in practice.
Language	English
Publishing date	2024-02-01
Publishing country	England
Document type	Journal Article
ZDB-ID	1104775-6
ISSN	1464-5165 ; 0963-8288
ISSN (online)	1464-5165
ISSN	0963-8288
DOI	10.1080/09638288.2024.2310760
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Article ; Online: A prospective assessment of gait kinematics and related clinical examination measures in cerebral palsy crouch gait.

O'Sullivan, Rory / French, Helen / Horgan, Frances

HRB open research

2023 Volume 5, Page(s) 81

Abstract: Background While prospectively assessed crouch gait in cerebral palsy (CP) does not necessarily progress, prospective changes in clinical examination measures have not been reported. This study prospectively examined the association between selected ... ...

Abstract	Background While prospectively assessed crouch gait in cerebral palsy (CP) does not necessarily progress, prospective changes in clinical examination measures have not been reported. This study prospectively examined the association between selected clinical examination variables and change in crouch gait in a cohort with bilateral CP. Methods Inclusion criteria were a diagnosis of ambulant bilateral CP, knee flexion at mid-stance >19
Language	English
Publishing date	2023-08-07
Publishing country	Ireland
Document type	Journal Article
ISSN	2515-4826
ISSN (online)	2515-4826
DOI	10.12688/hrbopenres.13647.2
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Article ; Online: Comprehensive geriatric assessment-where are we now, where do we need to be in the context of global ageing?

Naughton, Corina / Galvin, Rose / McCullagh, Ruth / Horgan, Frances

Age and ageing

2023 Volume 52, Issue 11

Abstract: Comprehensive geriatric assessment (CGA) is the cornerstone of modern geriatric medicine and the framework around which conventional and new models of care for older people are developed. Whilst there are a substantial number of reviews synthesising the ... ...

Abstract	Comprehensive geriatric assessment (CGA) is the cornerstone of modern geriatric medicine and the framework around which conventional and new models of care for older people are developed. Whilst there are a substantial number of reviews synthesising the evidence on patient and service outcomes from CGA, as an intervention it remains poorly described. There is a lack of detail on how a CGA plan is coordinated, delivered and followed up, especially outside of acute care. This commentary reflects on the authors' experience of extracting data from 57 published studies on CGA. CGA as an intervention is akin to a 'black box' in terms of describing and measuring participants' interactions with CGA activity in terms of time, frequency and amount (dose) received. There is also a lack of detail on how newly established CGA teams become effective, interdisciplinary, high functioning and sustainable teams. The CGA knowledge-do gap persists with a need to draw from complex system theory and implementation science frameworks to better describe the intervention and understand the influence of the organisation and health service within which CGA is operationalised. Equally, the voice of older people, families and staff is critical in the conduct and evaluation of CGA, and how it evolves as a model to meet the growing needs of ageing populations.
MeSH term(s)	Humans ; Aged ; Geriatric Assessment ; Aging ; Geriatrics
Language	English
Publishing date	2023-11-15
Publishing country	England
Document type	Journal Article
ZDB-ID	186788-x
ISSN	1468-2834 ; 0002-0729
ISSN (online)	1468-2834
ISSN	0002-0729
DOI	10.1093/ageing/afad210
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Zs.A 877: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular Jg. 1995 - 2021: Lesesall (1.OG) ab Jg. 2022: Lesesaal (EG)
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Article ; Online: The impact of stroke, cognitive function and post-stroke cognitive impairment (PSCI) on healthcare utilisation in Ireland: a cross-sectional nationally representative study.

Jeffares, Isabelle / Rohde, Daniela / Doyle, Frank / Horgan, Frances / Hickey, Anne

BMC health services research

2022 Volume 22, Issue 1, Page(s) 414

Abstract: Background: Cognitive impairment after stroke is associated with poorer health outcomes and increased need for long-term care. The aim of this study was to determine the impact of stroke, cognitive function and post-stroke cognitive impairment (PSCI) on ...

Abstract	Background: Cognitive impairment after stroke is associated with poorer health outcomes and increased need for long-term care. The aim of this study was to determine the impact of stroke, cognitive function and post-stroke cognitive impairment (PSCI) on healthcare utilisation in older adults in Ireland. Methods: This cross-sectional study involved secondary data analysis of 8,175 community-dwelling adults (50 + years), from wave 1 of The Irish Longitudinal Study on Ageing (TILDA). Participants who had been diagnosed with stroke by a doctor were identified through self-report in wave 1. Cognitive function was measured using the Montreal Cognitive Assessment (MoCA). The main outcome of the study was healthcare utilisation, including General Practitioner (GP) visits, emergency department visits, outpatient clinic visits, number of nights admitted to hospital, and use of rehabilitation services. The data were analysed using multivariate adjusted negative binomial regression and logistic regression. Incidence-rate ratios (IRR), odds ratios (OR) and 95% confidence intervals (CI) are presented. Results: The adjusted regression analyses were based on 5,859 participants who completed a cognitive assessment. After adjusting for demographic and clinical covariates, stroke was independently associated with an increase in GP visits [IRR (95% CI): 1.27 (1.07, 1.50)], and outpatient service utilisation [IRR: 1.49 (1.05, 2.12)]. Although participants with poor cognitive function also visited the GP more frequently than participants with normal cognitive function [IRR: 1.07 (1.04, 1.09)], utilisation of outpatient services was lower in this population [IRR: 0.92 (0.88, 0.97)]. PSCI was also associated with a significant decrease in outpatient service utilisation [IRR: 0.75 (0.57, 0.99)]. Conclusions: Stroke was associated with higher utilisation of GP and outpatient services. While poor cognitive function was also associated with more frequent GP visits, outpatient service utilisation was lower in participants with poor cognitive function, indicating that cognitive impairment may be a barrier to outpatient care. In Ireland, the lack of appropriate neurological or cognitive rehabilitation services appears to result in significant unaddressed need among individuals with cognitive impairment, regardless of stroke status.
MeSH term(s)	Aged ; Cognition ; Cognitive Dysfunction/epidemiology ; Cognitive Dysfunction/etiology ; Cross-Sectional Studies ; Humans ; Ireland/epidemiology ; Longitudinal Studies ; Patient Acceptance of Health Care
Language	English
Publishing date	2022-03-29
Publishing country	England
Document type	Journal Article
ZDB-ID	2050434-2
ISSN	1472-6963 ; 1472-6963
ISSN (online)	1472-6963
ISSN	1472-6963
DOI	10.1186/s12913-022-07837-2
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Article ; Online: A qualitative evidence synthesis exploring people after stroke, family members, carers and healthcare professionals' experiences of early supported discharge (ESD) after stroke.

Connor, Elaine O / Dolan, Eamon / Horgan, Frances / Galvin, Rose / Robinson, Katie

PloS one

2023 Volume 18, Issue 2, Page(s) e0281583

Abstract: Objective: Early supported discharge (ESD) after stroke has been shown to generate significant cost savings and reduce both hospital length of stay, and long-term dependency. This study aimed to systematically review and synthesise qualitative studies ... ...

Abstract	Objective: Early supported discharge (ESD) after stroke has been shown to generate significant cost savings and reduce both hospital length of stay, and long-term dependency. This study aimed to systematically review and synthesise qualitative studies of the experiences and views of ESD from the perspective of people after stroke, their family members, carers and healthcare professionals. Method: A systematic search of eleven databases; CINAHL, PubMed Central, Embase, MEDLINE, PsycINFO, Sage, Academic Search Complete, Directory of Open Access Journal, The Cochrane Library, PsycARTICLES and SCOPUS, was conducted from 1995 to January 2022. Qualitative or mixed methods studies that included qualitative findings on the perspectives or experiences of people after stroke, family members, carers and healthcare professionals of an ESD service were included. The protocol was registered with the Prospero database (Registration: CRD42020135197). The methodological quality of studies was assessed using the 10-item CASP checklist for qualitative studies. Results were synthesised using Thomas and Harden's three step approach for thematic synthesis. Results: Fourteen studies were included and five key themes were identified (1) ESD eases the transition home, but not to community services, (2) the home environment enhances rehabilitation, (3) organisational, and interprofessional factors are critical to the success of ESD, (4) ESD is experienced as a goal-focused and collaborative process, and (5) unmet needs persisted despite ESD. Conclusion: The findings of this qualitative evidence synthesis highlight that experiences of ESD were largely very positive. The transition from ESD to community services was deemed to be problematic and other unmet needs such as information needs, and carer support require further investigation.
MeSH term(s)	Humans ; Caregivers ; Delivery of Health Care ; Family ; Patient Discharge ; Qualitative Research ; Stroke/therapy
Language	English
Publishing date	2023-02-13
Publishing country	United States
Document type	Journal Article ; Systematic Review
ZDB-ID	2267670-3
ISSN	1932-6203 ; 1932-6203
ISSN (online)	1932-6203
ISSN	1932-6203
DOI	10.1371/journal.pone.0281583
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Article ; Online: Healthcare professionals' experiences of delivering a stroke Early Supported Discharge service - An example from Ireland.

O Connor, Elaine / Dolan, Eamon / Horgan, Frances / Galvin, Rose / Robinson, Katie

Clinical rehabilitation

2023 Volume 38, Issue 3, Page(s) 414–426

Abstract: Objective: To explore healthcare professionals' experiences of the development and delivery of Early Supported Discharge for people after stroke, including experiences of the COVID-19 pandemic.: Design: Qualitative descriptive study using one-to-one ... ...

Abstract	Objective: To explore healthcare professionals' experiences of the development and delivery of Early Supported Discharge for people after stroke, including experiences of the COVID-19 pandemic. Design: Qualitative descriptive study using one-to-one semi-structured interviews. Data were analysed using reflexive thematic analysis. Setting: Nine Early Supported Discharge service sites in Ireland. Participants: Purposive sampling identified 16 healthcare professionals. Results: Five key themes were identified (1) Un-coordinated development of services, (2) Staff shortages limit the potential of Early Supported Discharge, (3) Limited utilisation of telerehabilitation post COVID-19 pandemic, (4) Families need information and support, and (5) Early Supported Discharge involves collaboration with people after stroke and their families. Conclusions: Findings highlight how Early Supported Discharge services adapted during the COVID-19 pandemic and how gaps in the service impacts on service delivery. Practice implications include the need to address staff recruitment and retention issues to prevent service shortages and ensure consistent access to psychology services. Early Supported Discharge services should continue to work closely with families and address their information and support needs. Future research on how telerehabilitation can optimally be deployed and the impact of therapy assistants in Early Supported Discharge is needed.
MeSH term(s)	Humans ; Ireland ; Patient Discharge ; Pandemics ; Stroke/diagnosis ; Stroke/therapy ; Qualitative Research ; Delivery of Health Care ; COVID-19/epidemiology
Language	English
Publishing date	2023-12-06
Publishing country	England
Document type	Journal Article
ZDB-ID	639276-3
ISSN	1477-0873 ; 0269-2155
ISSN (online)	1477-0873
ISSN	0269-2155
DOI	10.1177/02692155231217363
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Zs.A 2297: Show issues

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Article ; Online: A prospective assessment of the progression of flexed-knee gait over repeated gait analyses in the absence of surgical intervention in bilateral cerebral palsy.

O'Sullivan, Rory / French, Helen P / Horgan, Frances

Gait & posture

2020 Volume 79, Page(s) 133–138

Abstract: Background: Flexed-knee gait is a common pattern associated with cerebral palsy (CP). It leads to excessive forces on the knee and is thought to contribute to pain and deformity. While studies have shown improvements in mid-stance knee flexion following ...

Abstract	Background: Flexed-knee gait is a common pattern associated with cerebral palsy (CP). It leads to excessive forces on the knee and is thought to contribute to pain and deformity. While studies have shown improvements in mid-stance knee flexion following surgery there remains a lack of prospective data on the progression of flexed-knee gait in the absence of surgery. Research question: Does knee flexion progress over repeated assessments in the absence of surgery in a prospectively assessed cohort with CP? Methods: Inclusion criteria were a diagnosis of bilateral CP, knee flexion at mid-stance >19° and no surgery within one year of the first gait analysis. Gait analysis was carried out at six-month intervals (minimum of three and maximum of six assessments). The progression of knee flexion over repeated analyses was assessed. The association between changes in knee flexion between assessments and gender, age, GMFCS level, change in ankle dorsiflexion, change in height and change in weight was examined. Results: Forty-eight participants met the initial inclusion criteria and 32 (GMFCS I = 11, II = 17, III = 4) completed the minimum three assessments. Of the 32 included participants, 21 participants (66%) demonstrated decreased knee flexion at mid-stance (mean decrease 6.6° ± 3.4°; range 2.0°-13.0°) and 11 participants (34%) demonstrated increased knee flexion at mid-stance (mean increase 10.4° ± 7.1°; range 2.0°-20.0°) at one-year follow-up. Eighteen (56%) then demonstrated an overall decrease (mean 7.4° ± 5.1°) in knee flexion between the first and last assessment with last follow-up at 1-2 years (n = 3), 2-3 years (n = 3) and 3-4 years (n = 12). The majority of participants (78%) demonstrated episodes of both increasing and decreasing Knee flexion between individual assessments and further analysis found that age was associated with this inter-assessment variability in knee flexion. Significance: Flexed-knee gait is not always progressive in bilateral CP and demonstrated variability associated with age.
MeSH term(s)	Adolescent ; Biomechanical Phenomena ; Cerebral Palsy/physiopathology ; Child ; Child, Preschool ; Female ; Gait Analysis ; Humans ; Male ; Prospective Studies ; Young Adult
Language	English
Publishing date	2020-05-01
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	1162323-8
ISSN	1879-2219 ; 0966-6362
ISSN (online)	1879-2219
ISSN	0966-6362
DOI	10.1016/j.gaitpost.2020.04.021
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Article ; Online: Effectiveness of interventions to support the transition home after acute stroke: a protocol for a systematic review.

O'Callaghan, Geraldine / Fahy, Martin / Murphy, Paul / Langhorne, Peter / Galvin, Rose / Horgan, Frances

HRB open research

2022 Volume 4, Page(s) 105

Abstract: Background Despite advances in the quality of acute stroke management, there are gaps in knowledge about effective support interventions to better manage the transition of care to home for patients with this complex condition. The goal of this ... ...

Abstract	Background Despite advances in the quality of acute stroke management, there are gaps in knowledge about effective support interventions to better manage the transition of care to home for patients with this complex condition. The goal of this systematic review is to explore the literature around support interventions available for patients as they navigate from acute hospital, rehabilitation or early supported discharge (ESD) services to independent living at home; and to establish if, in comparison with usual care or other comparative active interventions, support services offered to patients as they transition from acute hospital, inpatient rehabilitation/ESD to home, can achieve better patient and / or process outcomes. Protocol In June 2021, we will carry out, on electronic peer-reviewed databases, a comprehensive literature search based on a pre-defined search strategy, developed and conducted in collaboration with an Information Specialist. In an effort to identify all published trials we will perform citation tracking of included studies, check reference lists of relevant articles, review grey literature, and extend our search to google scholar. We will include randomised controlled trials (including cluster and quasi-randomisation) recruiting stroke patients transitioning to home, to receive either usual care or any support intervention designed to improve outcomes after stroke. The primary clinical outcome will be functional status. Two review authors will scrutinise trials, categorise them on their eligibility, and extract data. We will analyse the results for all trials and perform meta-analyses where possible. We will assess risk of bias for the included trials and use GRADE to assess the quality of the body of evidence. Patient and public involvement (PPI) engaged in the development of the research questions, and will participate in co-design of a strategy for dissemination of findings.
Language	English
Publishing date	2022-03-11
Publishing country	Ireland
Document type	Journal Article
ISSN	2515-4826
ISSN (online)	2515-4826
DOI	10.12688/hrbopenres.13364.2
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Article: Examining the factors associated with community ambulation in an older adult day hospital population.

Conroy, Bronagh / Murphy, Niamh / Romero-Ortuno, Roman / Cunningham, Conal / Horgan, Frances

European geriatric medicine

2022 Volume 13, Issue 5, Page(s) 1137–1147

Abstract: Purpose: The ability of an older adult to walk independently in their community assists with maintaining independence, a healthy lifestyle and a good quality of life. In clinical practice, outdoor mobility is often one of the first activities, where a ... ...

Abstract	Purpose: The ability of an older adult to walk independently in their community assists with maintaining independence, a healthy lifestyle and a good quality of life. In clinical practice, outdoor mobility is often one of the first activities, where a decline is observed. The aim of this study was to examine the factors associated with community ambulation in community dwelling older adults attending a day hospital. Methods: This was a cross-sectional observational study design. Inclusion criteria were community dwelling older adults, over 65 years, attending a day hospital and able to ambulate at least 10 m with or without an assistive device. The primary outcome measure was a community ambulation questionnaire. A range of other outcome measures were completed assessing motor, cognitive, executive function and behavioural domains. Multivariate logistic regression was employed to identify independent predictors of community ambulation. Results: 161 participants completed this study. The median age was 83 years (IQR 9), 64% were female and 49.1% lived alone. 55.3% of participants were classified as independent community ambulators. Mean gait speed was 0.8 m/s, median TUG score was 16.6 s and median frailty was 4 (IRQ 2) using the Clinical Frail Scale. Self-efficacy (p < 0.001) and gait speed (p = 0.030) were independently associated with community ambulation. Conclusions: The findings demonstrate the complexity and multifactorial nature of community ambulation in older adults. This suggests the need to adopt a broader approach to the management of older adults, to promote the achievement of independent community ambulation.
MeSH term(s)	Aged ; Aged, 80 and over ; Cross-Sectional Studies ; Female ; Gait ; Hospitals ; Humans ; Male ; Quality of Life ; Walking
Language	English
Publishing date	2022-07-05
Publishing country	Switzerland
Document type	Journal Article ; Observational Study ; Research Support, Non-U.S. Gov't
ZDB-ID	2556794-9
ISSN	1878-7657 ; 1878-7649
ISSN (online)	1878-7657
ISSN	1878-7649
DOI	10.1007/s41999-022-00666-w
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Article ; Online: Effectiveness of interventions to support the transition home after acute stroke: a systematic review and meta-analysis.

O'Callaghan, Geraldine / Fahy, Martin / Murphy, Paul / Langhorne, Peter / Galvin, Rose / Horgan, Frances

BMC health services research

2022 Volume 22, Issue 1, Page(s) 1095

Abstract: Background: Effective support interventions to manage the transition to home after stroke are still mostly unknown.: Aim: The purpose of this systematic review was to investigate the effectiveness of support interventions at transition from organised ...

Abstract	Background: Effective support interventions to manage the transition to home after stroke are still mostly unknown. Aim: The purpose of this systematic review was to investigate the effectiveness of support interventions at transition from organised stroke services to independent living at home. Methods: The Cochrane Central Register of Controlled Trials, six databases including MEDLINE and Embase, trial registries, grey literature, and Google Scholar were all searched, up to June 2021. We included randomised controlled trials enrolling people with stroke to receive either standard care or any type of support intervention from organised stroke services to home. The primary outcome was functional status. Two authors determined eligibility, extracted data, evaluated risk of bias (ROB2), and verified the evidence (GRADE). Where possible we performed meta-analyses using Risk Ratios (RR) or Mean Differences (MD). Results: We included 17 studies. Support interventions led to important improvements in functional status, as determined by the Barthel Index up, to 3-months (MD 7.87 points, 95%CI:6.84 to 19.16; 620 participants; five studies; I Conclusions: Incorporating support interventions as people who have experienced a stroke transition from hospital to home can improve functional status and other outcomes. Due to study heterogeneity, the essential components of effective transition of care interventions are still unknown. Adoption of core outcome sets in stroke research would allow for greater comparison across studies. Application of a development and evaluation framework engaging stakeholders would increase understanding of priorities for stroke survivors, and inform the key components of an intervention at transition from hospital-to-home. Trial registration: CRD42021237397 - https://www.crd.york.ac.uk/prospero.
MeSH term(s)	Anxiety ; Humans ; Independent Living ; Quality of Life ; Stroke ; Stroke Rehabilitation
Language	English
Publishing date	2022-08-28
Publishing country	England
Document type	Journal Article ; Meta-Analysis ; Systematic Review
ZDB-ID	2050434-2
ISSN	1472-6963 ; 1472-6963
ISSN (online)	1472-6963
ISSN	1472-6963
DOI	10.1186/s12913-022-08473-6
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