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Increasing numbers of people are living with stroke, due to population ageing and improved survival, leading to a need for evidence to inform future policy decision-making. This study aimed to engage with stakeholders in Ireland to identify priorities for stroke services development. A sequential mixed methods design was used. Phase 1 (qualitative) was exploratory, involving initial priority gathering via an online qualitative survey and interviews, with stroke survivors, family/main carers, and professionals working in stroke care. Framework analysis was used to generate a long-list of improvements to stroke services. Phase 2 involved a quantitative survey, where stakeholders selected five priority improvements from the long-list. Results were discussed in a stakeholder meeting. In-depth interviews were completed with 18 survivors, 13 carers and 8 professionals, while 80 professionals took part in a qualitative survey (phase 1). Priority areas of care were identified and a long-list of 45 priority improvements was generated. In phase 2, 34 survivors, 19 family carers and 42 professionals completed a survey. The highest priority improvements (selected by >20% of respondents) were access to specialist neuro-rehabilitation, ongoing support for life after stroke, recruitment/retention of specialist staff, improved information and support for health system navigation, and access to specialist acute care. Stroke survivors/carers prioritised exploring ways to improve access for strokes with atypical presentation, while professionals prioritised specialist inpatient rehabilitation and early supported discharge. Neither group prioritised stroke prevention. Based on discussions in the stakeholder meeting (n = 12), it was decided that support for mental health should also be included as a priority. The development of stroke services benefits from exploring the priorities of those receiving and delivering stroke care. Findings emphasise the need for equitable access to high quality adequately-staffed services, particularly post-discharge, that are easy to navigate, with good communication, and effective information provision.

ObjectiveUnderstanding future population needs is key for informing stroke service planning. This study aims to evaluate scenarios for future trends in stroke age-specific incidence and case fatality, and estimate their impact on projected stroke and poststroke dementia prevalence in Ireland.DesignThis is an epidemiological modelling study based on a probabilistic Markov model. We extrapolated trends in age-specific stroke incidence and case fatality from 1990 to 2019 and applied these to 2016 to 2046. We defined trend scenarios based on stability and low and high decline, broadly based on the lower and upper bounds of evidence for trends to date. We also examined nonlinear trends involving decelerating decline over time and varying trends by age.Setting/participantsThe study is conducted on the Irish population aged 40–89 years in the period 2022–2046. We used multiple data sources, including systematic review and observational evidence.InterventionsNot applicable.Primary and secondary outcome measuresWe projected the incidence and prevalence of stroke (International Classification of Disease (ICD) codes I60–I61, I63–I64), poststroke dementia (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V) criteria) and poststroke disability (modified Rankin Scale 3–5).ResultsThe stable scenario indicated a projected 85 834 stroke survivors in 2046 (95% uncertainty interval (UI)=82 366–89 655), an increase of 45.7% from 2022. Assuming a high incidence decline and low case-fatality decline indicated a 5.4% increase in prevalence. Intermediate scenarios based on lower rates of decline, or decline rates slowing over time, implied an increase between 25.8% and 40.3%. Results did not differ substantially when we varied trends by age.In the stable scenario, we projected 16 978 poststroke dementia prevalent cases in 2046 (95% UI 14 958–19 157), an increase of 58.9% from 2022. In the high decline scenario, the increase would be 24.5%, with intermediate scenarios implying an increase between 41.3% and 56.3%.ConclusionsFuture stroke healthcare needs will vary substantially depending on epidemiological trends. There is an urgent need to both invest in prevention strategies and plan for likely increases in future stroke care needs.

Physical inactivity post‐stroke increases risk of recurrent stroke. Adaptive physical activity (PA) interventions are recommended, and alternative designs, such as sequential multiple assignment randomized trials (SMARTs) can be used. This SMART investigates the feasibility of a mobile health (mHealth) PA intervention post‐stroke. People post‐stroke are randomized to 12‐week online exercise (EX) or lifestyle PA (LPA). Six‐week daily step count data are used to classify participants as responders or nonresponses. Nonresponders are re‐randomized to switch or augment their mHealth intervention, responders continue unchanged. Primary outcomes include recruitment, retention and adherence rates. Secondary outcomes include PA, sedentary behavior, fatigue, quality of life, psychological distress, and activities of daily living. General linear models estimate trends regarding first‐stage interventions, nonresponse strategies, and adaptive interventions are examined using weighted and replicated regressions. Fifty participants are included. Recruitment, retention, and adherence rates are 85%, 84%, and 82%. Positive trends are seen for nonresponse strategies, switching interventions, on step count, fatigue, and quality of life. Starting with EX and switching to LPA show potential benefits for fatigue, quality of life and return to normal living. Potential benefits of these interventions are preliminary and require validation in a full‐scale trial. This SMART offers novel evidence supporting the design of adaptive mHealth PA interventions post‐stroke, confirming the feasibility of a definitive SMART. This study examines the feasibility of a mobile health physical activity intervention for individuals post‐stroke using a sequential multiple assignment randomized trial (SMART) design. High recruitment, retention, and adherence rates are observed, with promising trends in step count, fatigue, and quality of life. Findings indicate potential for progression to a full‐scale trial.

BackgroundStroke and post-stroke dementia prevalence projections are key for informing health policy and planning. However, future trends in stroke incidence are uncertain. The Irish population is ageing rapidly, and stable age-specific incidence rates will result in large projected increases in prevalent stroke and consequent dementia. This study aims to evaluate alternative scenarios for future trends in age-specific stroke incidence, and estimate the impact on projected prevalence of stroke and post-stroke dementia in Ireland to 2046.MethodsWe used a probabilistic Markov model, previously developed by our group, to project and track incidence and prevalence of stroke and post-stroke dementia in the Irish population aged 40–89 years to 2046. Data sources included official population and hospital episode statistics, and national and international longitudinal cohort studies. Drawing on evidence from systematic reviews and recent observational studies, we extrapolated trends in stroke incidence from 1990 to 2019 to the period 2016 to 2046. We explored five scenarios – stable incidence over time, and annual declines in stroke incidence of 1.0%, 1.5%, 2.0% and 2.5%.ResultsIn the stable age-specific incidence scenario, there will be a projected 79,863 stroke survivors aged 40–89 years in 2046 living in Ireland (95% uncertainty interval, UI = 75,845–83,8987) (23.4 per 1000 pop), an increase of 115% from 2016, due to changing population age structure. Of these, 14,996 (UI = 12,248–17,966) are projected to have dementia, a 217% increase from 2016. Assuming a 1.0% rate of annual decline in stroke incidence, there will be a projected 62,905 stroke survivors (95% UI = 59,407–66,298) in 2046, an increase of 70% from 2016. Of these, 12,415 (UI = 10,083–14,906) are projected to have dementia, a 161% increase from 2016. In the most optimistic scenario (annual decline of 2.5%), projected stroke prevalence will increase from 2016 to 2046 by 13.5% to 46,090 (95% UI = 43,641–48,970). Of these, 9,918 (UI = 7,963–12,189) are projected to have dementia, an 108% increase from 2016.ConclusionIf age-specific stroke incidence rates remain stable in Ireland, there will be substantial increases in prevalent stroke and post-stroke dementia with consequent needs to expand services. If recent trends towards decline in stroke incidence continue, this increase in prevalence will be substantially reduced. Limitations include the inherent uncertainty regarding future trends, and use of international data where Irish data was not available. Strengths include use of best available evidence, extensive sensitivity analysis, and consideration of multiple scenarios.

Introduction: A stroke can have devastating effects for the person themselves and their families and means adjusting their lives. Stroke support groups offer stroke survivors and their caregivers/families a chance to share concerns and support each other in a positive environment as they adjust to changes in their lives. Currently in Ireland, there are over 30,000 stroke survivors with annual prevalence of stroke estimated to be approximately 10,000 (IHF 2014). Roscommon is a small rural county in the west of Ireland with population of over 64,000. Here, the Clinical Nurse Specialist (CNS) in Stroke and the Senior Speech and Language Therapist (SLT), identified that there was a significant need for a stroke support group (SSG). The IHF (2014) had also identified a gap in the presence of stroke support groups in many regions of Ireland, particularly rural Ireland.Practice Change Implemented: A working group was formulated to establish a SSG in Roscommon, which included; CNS in stroke, Senior SLT, IHF, Consultant Geriatrician, Public Health Nurse, Clinical Nurse Manager from local rehabilitation facility and Occupational Therapist from Quest Brain Injury Services. This group was a combination of acute, rehabilitation and primary care professionals, HSE and voluntary bodies, all working together with the ultimate aim of establishing a SSG for the people of Roscommon and the surrounding area. The IHF committed to employing a SSG co-ordinator to run the group. All members working with stroke survivors, sought consent for their name and contact details to be added to a database. Everyone on this database received correspondence regarding the SSG. A public meeting to launch the SSG was held. A SSG co-ordinator was recruited. The SSG meet on a weekly basis.Aim & Theory of Change: The SSG aims to provide stroke survivors and their families with peer and social support, enabling them to feel more empowered to live meaningful lives after their stroke.Targeted Population & Stakeholders: The target population is stroke survivors in Roscommon and the surrounding area. The key stakeholders are stroke survivors, their families, IHF and the professionals involved in the SSG.Timeline: The initial meeting with Senior SLT, stroke CNS and the IHF took place in May 2016, with the working group formed in June 2016. A public meeting was held in September 2016 with the first SSG meeting taking place in October 2016.Highlights: The SSG runs weekly with positive outcomes including; a sense of belonging, improved social support and interaction, education and information, and increased confidence. The SSG is also seen as a link for help.Comments on sustainability: The SSG meets on a weekly basis and the sustainability of this is possible due to the commitment of the IHF in providing a SSG co-ordinator.Comments on transferability: The Roscommon SSG is the first to be established by the IHF in rural Ireland, however in 2017 at least eight additional SSGs will be established throughout Ireland. This is in addition to the existing 20 SSGs that are in operation, including ten SSGs that are part of the IHF network.