Objective

Access to a specialized rehabilitation is limited for most of post stroke patients who are often transferred in non-specialized rehabilitation hospitals. We have set up a multidisciplinary mobile team working in these hospitals. The aim of this pilot study was to describe the contribution of our mobile team specialized in post acute care of stroke.

Materials/patients and methods

We collected the changes in the management of rehabilitation for 31 patients hospitalized in non-specialized rehabilitation hospital referred to our mobile team. We assessed the training of healthcare workers that we provided and the impact on the care pathway.

Results

Our team permitted for almost all patients a specialized assessment (occupational therapy, referred for a psychological or neuropsychological assessment, a social evaluation, further evaluation, including specific neurovascular investigations). Therapeutic was changed, including learning self-rehabilitation methods, physiotherapy, and speech therapy. An adaptation of the care pathway has been done (neurovascular consultations, change of place of life project, accompanying a return home and reorientation in specialized rehabilitation unit). The team also permitted a training of the paramedical crew. All the doctors who requested the team declared this intervention as facilitator for admission of post-stroke patients in their hospital.

Discussion/Conclusion

These results show that our rehabilitation mobile team provides a large and diverse contribution to the non-specialized hospitals. This support covers all medical and social aspects. Beyond the individual impact, it helps, with training, to improve overall care and quality of care for non-specialized hospitals. Our results also suggest our mobile team is a facilitator for admission in post acute post-stroke unit.