title: Compliance with Australian stroke guideline recommendations for outdoor mobility and transport training by post-inpatient rehabilitation services: An observational cohort study.
abstract: BACKGROUND
  Community participation is often restricted after stroke, due to reduced confidence and outdoor mobility. Australian clinical guidelines recommend that specific evidence-based interventions be delivered to target these restrictions, such as multiple escorted outdoor journeys. The aim of this study was to describe post-inpatient outdoor mobility and transport training delivered to stroke survivors in New South Wales, Australia and whether therapy differed according to type, sector or location of service provider.
  
  
  METHODS
  Using an observational retrospective cohort study design, 24 rehabilitation service providers were audited. Provider types included outpatient (n = 8), day therapy (n = 9), home-based rehabilitation (n = 5) and transitional aged care services (TAC, n = 2). Records of 15 stroke survivors who had received post-hospital rehabilitation were audited per service, for wait time, duration, amount of therapy and outdoor-related therapy.
  
  
  RESULTS
  A total of 311 records were audited. Median wait time for post-hospital therapy was 13 days (IQR, 5-35). Median duration of therapy was 68 days (IQR, 35-109), consisting of 11 sessions (IQR 4-19). Overall, a median of one session (IQR 0-3) was conducted outdoors per person. Outdoor-related therapy was similar across service providers, except that TAC delivered an average of 5.4 more outdoor-related sessions (95% CI 4.4 to 6.4), and 3.5 more outings into public streets (95% CI 2.8 to 4.3) per person, compared to outpatient services.
  
  
  CONCLUSIONS
  The majority of service providers in the sample delivered little evidence-based outdoor mobility and travel training per stroke participant, as recommended in national stroke guidelines.
  
  
  BACKGROUND
  Australian and New Zealand Clinical Trials Registry ACTRN12611000554965.
authors.affiliation: Discipline of Occupational therapy, Faculty of Health Sciences, The University of Sydney, Sydney, NSW, Australia. annie.mccluskey@sydney.edu.au.
authors.forename: Annie
authors.initials: A
authors.lastname: McCluskey
authors.affiliation: Discipline of Physiotherapy, Faculty of Health Sciences, The University of Sydney, Sydney, NSW, Australia. louise.ada@sydney.edu.au.
authors.forename: Louise
authors.initials: L
authors.lastname: Ada
authors.affiliation: Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia. patrick.kelly@sydney.edu.au.
authors.forename: Patrick J
authors.initials: PJ
authors.lastname: Kelly
authors.affiliation: Nursing Research Institute, St Vincent's Health Australia (Sydney) and Australian Catholic University, Level 5, DeLacey Building, St Vincent's Hospital, Darlinghurst, NSW, 2010, Australia. sandy.middleton@acu.edu.au.
authors.forename: Sandy
authors.initials: S
authors.lastname: Middleton
authors.affiliation: Centre for Health Economics Research and Evaluation, University of Technology Sydney, Sydney, NSW, Australia. stephen.goodall@chere.uts.edu.au.
authors.forename: Stephen
authors.initials: S
authors.lastname: Goodall
authors.affiliation: Ottawa Health Research Institute and Department of Medicine, Clinical Epidemiology Program, University of Ottawa, Ottawa, Canada. jgrimshaw@ohri.ca.
authors.forename: Jeremy M
authors.initials: JM
authors.lastname: Grimshaw
authors.affiliation: University of Nottingham, England, UK. pip.logan@nottingham.ac.uk.
authors.forename: Pip
authors.initials: P
authors.lastname: Logan
authors.affiliation: NSW Agency for Clinical Innovation, Sydney, NSW, Australia. mark.longworth@aci.health.nsw.gov.au.
authors.forename: Mark
authors.initials: M
authors.lastname: Longworth
authors.affiliation: Discipline of Occupational therapy, Faculty of Health Sciences, The University of Sydney, Sydney, NSW, Australia. aspasia.karageorge@sydney.edu.au.
authors.forename: Aspasia
authors.initials: A
authors.lastname: Karageorge
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001315:Australia; D005260:Female; D019983:Guideline Adherence; D006296:Health Services; D006801:Humans; D007297:Inpatients; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D051346:Mobility Limitation; D009788:Occupational Therapy; D012189:Retrospective Studies; D000071939:Stroke Rehabilitation; D017741:Survivors; D057170:Translational Research, Biomedical