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Equine-assisted therapy (EAT) uses the horse and its environment to achieve therapeutic goals as designed by an allied health professional (Taylor, 2010). The benefits of these interventions affect areas such as motor skills (Bass et al., 2009; Silkwood-Sherer et al., 2012), sensory processing (Ward et al., 2013), learning, social interaction and socioemotional development (Bracher, 2000). It was felt that occupational therapists could offer valuable input in this area. This paper aims to investigate the impact of a specific six-week EAT programme on six participants’ occupational performance.

Mixed methods were used in this pilot study, consisting of a pre- and post-design with two follow-up periods. Participants were aged between 5 and10 years with a diagnosis of a visual impairment, and some had additional diagnoses. The Canadian Occupational Performance Measure (COPM) was administered to parents pre-programme, post-programme and approximately six week after the programme ceased. Additional information from notes that contained children’s and parents’ reports was analysed thematically.

Five of the six children were rated as having clinically significant changes in their occupational performance. Analysis of parents’ and children’s reports on their experience of the programme showed the main themes to be: peer interaction, taking on new challenges, feelings towards EAT and change.

Although there are many practitioners of EAT in Ireland, there is little research, and none was found in relation to the role of occupational therapists within this context. These results indicate that EAT may be effective in assisting some children to reach a variety of goals. This pilot study not only suggests that EAT is worth further research but also begins to explore the role of occupational therapy in this form of intervention.

There is a considerable disparity between clinical practice and recommendations based on meta-analyses of antipsychotic polypharmacy in clozapine resistant schizophrenia. For this reason, we investigated the clinical response to reducing the use olanzapine that had been previously added on clozapine treatment among seriously ill hospitalized patients. In a randomized controlled trial with crossover design, we studied volunteer patients (N=15) who had olanzapine added on to clozapine in a state mental hospital. Clozapine monotherapy was just as effective as clozapine-olanzapine therapy, according to results from Clinical Global Impression Scale and Global Assessment of Functioning as primary outcome measures. Polypharmacy is widely used in treating schizophrenia, and usually, add-on medications are started because of worsening of the clinical state. A major confounding feature of these add-ons is whether observed improvements are caused by the medication or explained by the natural fluctuating course of the disorder. The present study, in spite of its small size, indicates the necessity of reconsidering the value of polypharmacy in treating schizophrenia.

The outbreak of the COVID-19 pandemic has significantly impacted healthcare systems, presenting unforeseen challenges that necessitated the implementation of change management strategies to adapt to the new contextual conditions. This study aims to analyze organizational changes within the total hip replacement (THR) surgery pathway at multiple levels, including macro, meso and micro. It employs data triangulation from various sources to gauge the complexity of the change process and comprehend how multi-level decision-making influenced an unexpected shift.

A multicentric, single in-depth case study was conducted using a mixed-methods approach. Data sources included patient-reported outcome measures specific to the THR pathway and carefully structured in-depth interviews administered to managers and clinicians in two healthcare organizations serving the same population.

Decisions made at the macro level resulted in an overall reduction in surgical activities. Organizational changes at the meso level led to a complete cessation or partial reorganization of activities. Micro-level actions for change and adaptation revealed diverse and fragmented change management strategies.

Organizations with segmented structures may require a robust and structured department for coordinating change management responses to prevent the entire system from becoming stuck in the absorptive phase of change. However, it is important to recognize that absorptive solutions can serve as a starting point for genuine innovations in change management.

The utilization of data triangulation enables the authors to visualize how specific changes implemented in response to the pandemic have influenced the observed outcomes. From a managerial perspective, it provides insights into how future innovations could be introduced.

Health services continue to face economic and capacity challenges. Quality improvement (QI) methods that can improve clinical care processes are therefore needed. However, the successful use of current QI methods within hospital settings remains a challenge. There is considerable scope for improvement of elective clinical pathways, such as hip and knee replacement, and so the use and study of QI methods in such settings is warranted.

A model to manage variability was adapted for use as a QI method and deployed to improve a hip and knee replacement surgical pathway. A prospective observational study, with a mixed-methods sequential explanatory design (quantitative emphasised) that consisted of two distinct phases, was used to assess its effectiveness.

Following the use of the novel QI method and the subsequent changes to care processes, the length of hospital stay was reduced by 18%. However, the interventions to improve care process highlighted by the QI method were not fully implemented. The qualitative data revealed that staff thought the new QI method (the model to manage variability) was simple, effective, offered advantages over other QI methods and had highlighted the correct changes to make. However, they felt that contextual factors around leadership, staffing and organisational issues had prevented changes being implemented and a greater improvement being made.

The quality of QI reporting in surgery has previously been highlighted as poor and lacking in prospective and comprehensively reported mixed-methods evaluations. This study therefore not only describes and presents the results of using a novel QI method but also provides new insights in regard to important contextual factors that may influence the success of QI methods and efforts.

This study aims to establish a correlation between a patient’s mini mental state examination (MMSE) score and their ability to remember how to use common assistive dressing devices.

The study was a prospective, cross-sectional and correlational study. A final sample of 63 patients formed the study. Patients’ cognition was measured using the MMSE, and a new assessment tool was developed to assess patients’ ability to use three assistive devices and piloted on 15 patients to address normality, reliability, validity and clinical usefulness. Pearson’s rank correlation coefficient was used to establish direct correlations between the MMSE score and the assessment tool score. Eta squared was used to calculate the effect size to achieve an indication of the difference between the groups. Ethical approval had been granted by the regional ethics committee. The null hypothesis states that patients with an MMSE score of 22 or less show no difference in their ability to safely and appropriately use assistive devices provided and demonstrated by an occupational therapist than patients with an MMSE score of 23 or higher.

The null hypothesis was rejected and patients with an MMSE score of 22 or less showed a significant difficulty in their ability to use the three devices. Correlation coefficients showed significant positive correlations between MMSE scores and assistive devices scoring tool results for all three devices: Helping hand (r = 6.677, n = 60, p = 0.01), shoe horn (r = 0.649, n = 54, p = 0.01) and sock aid (r = 0.877, n = 54, p = 0.01).

The study is in an Irish context and demonstrated primary, objective evidence of the impact of impaired cognition on functional ability. Patients with cognitive deficits pose a larger safety challenge but still should be afforded an opportunity to use and benefit from assistive devices. The assessment tool is a new and unique instrument and although requires further development, may conceivably act not just as an assessment instrument but also an effective treatment tool.

Dementia is a complex, progressively degenerative condition. It results in loss of cognitive and functional capabilities, along with a significant increase in the level of dependency. A reduction in the use of pharmacological interventions correlates with an increased in good quality non-pharmacological interventions in dementia care. The purpose of this study is to examine the impact of 14-session face-to-face cognitive stimulation therapy (CST) and Sonas group interventions on individuals living with dementia with moderate cognitive impairment, from pre-intervention to post-intervention in terms of their cognition, communication, neuropsychiatric symptoms, activities of daily living and quality of life.

A pilot single blind prospective controlled trial evaluated two group intervention approaches, cognitive stimulation therapy (CST) and Sonas, with 28 participants with moderate dementia. Pseudorandomisation and single blinding were implemented. CST has a solid evidence base. Sonas is a widely used multi-sensory intervention in Ireland with an emerging evidence base. Participants were recruited from a mental health service. Participants who had a formal diagnosis of dementia, moderate cognitive impairment and some ability to communicate and understand communication were included.

Results supported CST to a greater extent than Sonas. The CST group showed significant changes in cognition (p = 0.032) and communication (p = 0.006). Both groups had significant changes in carer quality of life (CST, p = 0.019; Sonas, p = 0.035). Results support the recommendations for a future definitive trial.

Rehabilitation potential of individuals living with moderate dementia was demonstrated. This study suggests that group interventions like these impact on the trajectory of dementia.

Rehabilitation interventions impact on the trajectory of dementia. CST and Sonas have no impact on activities of daily living. Future studies with larger sample sizes, 16 weeks intervention period and control groups are required.

This pilot study supports CST over Sonas interventions for individuals living with moderate dementia. Multiple outcome measures demonstrated trends towards significance for both interventions. Future definitive trials may detect a significant effect of both interventions.

A dementia diagnosis is devastating and generally creates negative perceptions and associations (Alvira, 2014). In contrast, the outcomes of this study are positive. This study provides evidence that occupational therapist intervention can impact on the trajectory of the condition with people with dementia demonstrating that they do have rehabilitation potential by responding to treatment and improving and maintaining their abilities as they progress through the condition.

Sleep disturbance is a common difficulty in the general population. It has become particularly prevalent in the context of disruption to routine brought about by the COVID-19 pandemic. The purpose of this study was to trial a patient-guided “sleep workbook” intervention, which was developed by multidisciplinary team members, combining principles of sleep hygiene education and cognitive behavioural therapy for insomnia behavioural strategies, and to evaluate its efficacy in a mixed-methods study.

Service users of the community mental health service were invited to participate. A total of 30 service users agreed to participate. A total of 15 participants completed both the intervention and the mixed-methods survey. Four participated in the focus group. Descriptive and inferential statistics were performed on the collected quantitative data. A thematic analysis was carried out of qualitative survey responses and focus group discourse.

There was a statistically and clinically significant improvement in quantity and quality of sleep following intervention. Mean hours of sleep prior to the intervention was 4.4 hours [standard deviation (SD) = 2.2], compared to 6.1 hours (SD = 2.2) afterwards (p = 0.003). Quality of sleep improved from a mean of 2.5 (SD = 2.1) to 6.1 (SD = 2.3) following the intervention (p = <0.001). Four themes were developed using the qualitative data: “under-recognition of sleep difficulties”, “ruminations”, “practical utility” and “therapeutic autonomy”.

There is a growing need for occupational therapists and clinicians to provide interventions for patients with sleep difficulties and to develop sleep management practice. This patient-guided sleep workbook may be an effective intervention for these patients.

Impairments in social cognitions in schizophrenia are increasingly reported in the last decade but only a few studies have come from Asia. The objective of the study was to evaluated emotion perception, theory of mind and social knowledge in people with schizophrenia compared to healthy controls. Participants were 36 clinically stable outpatients with schizophrenia and 36 normal controls with comparable age and level of education. We administered general neurocognition test (the Addenbrooke's Cognitive Examination), emotion perception (the Faces Test), theory of mind (the Eyes Test) and social knowledge (the Situational Features Recognition Test; SFRT). Schizophrenia patients displayed obvious impairment in all three social cognition domains i.e. the Faces Test [13.7 (2.9) vs 15.7 (1.9), P=0.001], the Eyes Test [18.9 (4.4) vs 23.5 (4.4), P<0.001] and SFRT [0.85 (0.09) vs 0.9 (0.05), P=0.002]. The performances on three social cognition tests did not correlate with positive symptoms. Only the Faces Test seemed to be related to negative symptoms. The results demonstrated that there are deficits of social cognitions in schizophrenia even in a clinically stable population.

Kidney transplantation (KT) is the treatment of choice for end-stage chronic kidney disease (CKD) and is well known to improve the clinical outcome of patients. However, the impact of KT on comorbid psychological symptoms, particularly depression and anxiety, is less clear, and recipients of living-donor (LD) organs may have a different psychological outcome from recipients of dead-donor (DD) organs.

In total, 152 patients were included and analyzed using a cross-sectional design. Of these patients, 25 were pre-KT, 13 were post-KT with a LD transplant and 114 were post-KT with a DD transplant. The patients were tested for a variety of psychometric outcomes using the Hospital Anxiety and Depression Scale, the 12-Item Short Form Health Survey (assessing physical and mental health-related quality of life), the Resilience Scale, the Coping Self-Questionnaire and the Social Support Questionnaire.

The mean age of the patients was 51.25 years and 40 per cent of the patients were female. As expected, the post-KT patients had significantly better scores on the physical component of the Short Form Health Survey than the pre-KT patients, and there were no significant differences between the two post-KT groups. There were no significant differences among the groups in any of the other psychometric outcome parameters tested, including anxiety, depression and the mental component of health-related quality of life.

KT and the origin of the donor organ do not appear to have a significant impact on the psychological well-being of transplant patients with CKD. Although the diagnosis and early treatment of psychological symptoms, such as depression and anxiety, remain important for these patients, decisions regarding KT, including the mode of transplantation, should not be fundamentally influenced by concerns about psychological impairments at the population level.

CKD is a serious condition involving profound impairment of the physical and psychological well-being of patients. KT is considered the treatment of choice for most of these patients. KT has notable advantages over dialysis with regard to the long-term physical functioning of the renal and cardiovascular system and increases the life expectancy of patients. However, the data on the improvement of psychological impairments after KT are less conclusive.