title: A behavior change program to increase outings delivered during therapy to stroke survivors by community rehabilitation teams: The Out-and-About trial.
abstract: Australian guidelines recommend that outdoor mobility be addressed to increase participation after stroke.
  
  
  
  To investigate the efficacy of the Out-and-About program at increasing outings delivered during therapy by community teams, and outings taken by stroke survivors in real life.
  
  
  
  Cluster-randomized trial involving 22 community teams providing stroke rehabilitation. Experimental teams received the Out-and-About program (a behavior change program comprising a training workshop with barrier identification and booster session, printed educational materials, audit, and feedback). Control teams received printed clinical guidelines only. The primary outcome was the percentage of stroke survivors receiving four or more outings during therapy. Secondary outcomes included the number of outings received by stroke survivors during therapy and undertaken in real life.
  
  
  
  At 12 months after implementation of the behavior change program, 9% of audited experimental group stroke survivors received four or more outings during therapy compared with 5% in the control group (adjusted risk difference 4%, 95% CI - 9 to 17, p = 0.54). They received 1.1 (SD 0.9) outings during therapy compared with 0.6 (SD 1.0) in the control group (adjusted mean difference 0.5, 95% CI - 0.4 to 1.4; p = 0.26). After six months of rehabilitation, observed experimental group stroke survivors took 9.0 (SD 3.0) outings per week in real life compared with 7.4 (SD 4.0) in the control group (adjusted mean difference 0.5, 95% CI - 1.8 to 2.8; p = 0.63).
  
  
  
  The Out-and-About program did not change team or stroke survivor behavior.
authors.affiliation: Discipline of Occupational Therapy, Faculty of Health Sciences, The University of 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, NSW, Australia.
authors.forename: Louise
authors.initials: L
authors.lastname: Ada
authors.affiliation: Sydney School of Public Health, The University of Sydney, NSW, Australia.
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, NSW, Australia.
authors.forename: Sandy
authors.initials: S
authors.lastname: Middleton
authors.affiliation: Centre for Health Economics Research and Evaluation, University of Technology Sydney, NSW, Australia.
authors.forename: Stephen
authors.initials: S
authors.lastname: Goodall
authors.affiliation: Clinical Epidemiology Program, Ottawa Health Research Institute and Department of Medicine, University of Ottawa, Ottawa, Canada.
authors.forename: Jeremy M
authors.initials: JM
authors.lastname: Grimshaw
authors.affiliation: University of Nottingham, England, UK.
authors.forename: Pip
authors.initials: P
authors.lastname: Logan
authors.affiliation: NSW Agency for Clinical Innovation, NSW, Australia.
authors.forename: Mark
authors.initials: M
authors.lastname: Longworth
authors.affiliation: Discipline of Occupational Therapy, Faculty of Health Sciences, The University of Sydney, NSW, Australia.
authors.forename: Aspasia
authors.initials: A
authors.lastname: Karageorge
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D001315:Australia; D001521:Behavior Therapy / Q000379:methods; D003153:Community Health Services / Q000379:methods*; D003150:Community Health Workers; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020521:Stroke; D000071939:Stroke Rehabilitation / Q000379:methods*; D017741:Survivors; D014186:Transportation; D016896:Treatment Outcome; D016138:Walking
keywords: Physical therapy; knowledge translation; occupational therapy; physiotherapy; walking