Compliance with Australian stroke guideline recommendations for outdoor mobility and transport training by post-inpatient rehabilitation services: An observational cohort study

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. CONCLUSION 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. TRIAL REGISTRATION Australian and New Zealand Clinical Trials Registry ACTRN12611000554965.