Background: Early mobility is an essential component of organized stroke care however its application in low and middle income countries has received minimal research attention. Observational data from the Organized Stroke Care Across Income Levels (OSCAIL) study was used to describe current practice in 2 acute hospitals in Rwanda, and 1 in South Africa. 

Methods: Health records were audited for consecutive, consenting participants during and after hospitalization using a standardized data extraction form. The observation period was followed by implementation of a knowledge translation intervention aimed at identifying gaps in stroke care processes, education, development of site-specific action plans, and ongoing monitoring and feedback. 

Results: Out of a total of 209 patients (57.2 years; SD 15.5) with acute stroke, there was evidence of a mobility assessment for 46% during their inpatient stay; with 93% of these assessed within 1 day of admission. Assessments were completed by a physiotherapist (PT) (90.8%), occupational therapist (OT) (54%), physician (MD) (25.3%) and/or a nurse (6.0%). Mobility training was evident in 52% of patient-charts, and delivered by PTs (92.4%), OTs (50.0%), MDs (3.3%), and/or nurses (2.1%). In preparation for discharge, there was evidence of meeting with family (15%), referral for rehabilitation follow-up (9 %), stroke-related education (28.4%), and training of family in aspects of care (11 %). 
Conclusions:  While a majority of patients present with some mobility-related limitation, teams in low-resource environments may find it challenging to deliver and document best-practice mobility-related care. Simple multi-disciplinary mobility-focused interventions and collaborative knowledge-translation strategies have been developed to address gaps in this aspect of stroke care.

MOBILITY-RELATED CARE AFTER STROKE IN THE RWANDAN AND SOUTH AFRICAN CONTEXT: IDENTIFYING OPPORTUNITIES FOR IMPROVEMENT THROUGH THE ORGANIZED STROKE CARE ACROSS INCOME LEVELS (OSCAIL) STUDY