Stroke Rehabilitation in Low- and Middle-Income Countries: Challenges and Opportunities.
Grace Kayola, Mataa M Mataa, Melody Asukile and 6 others
PMID 36634327WHAT IT FOUND
Stroke rehabilitation in low- and middle-income countries is severely under-resourced, with few therapists and high patient costs.
Current guidelines often fail because they are not adapted to local realities. Effective solutions require community-based care, task-shifting to caregivers, and tele-rehabilitation.
Key findings
01In Zambia, only 27% of stroke patients received physical therapy during hospitalization, and no occupational or speech therapy services were available at the national referral hospital.
02Adopting high-income country guidelines without local adaptation fails due to resource constraints, whereas community-based rehabilitation and task-shifting offer more feasible pathways.
03Caregiver-led and tele-rehabilitation interventions show promise for feasibility and satisfaction but have not yet demonstrated significant improvements in functional outcomes compared to usual care in these settings.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTsWhat it means for SLPs
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What it does not show
This is a narrative review, not a systematic review or meta-analysis, so it may reflect author bias in selecting studies. Much of the specific data cited comes from the authors' unpublished work in Zambia, limiting generalizability to all LMICs. The review notes that evidence for interventions like telerehabilitation and task-shifting in LMICs is still emerging, with many studies being pilots or lacking power to detect functional changes.
Declared interests
The authors have no conflicts of interest to disclose. The work was supported by the National Institutes of Health (Extramural).
The easy way to misread this
Do not interpret the lack of significant functional outcomes in caregiver-led or telerehabilitation trials as proof that these interventions do not work. The review suggests these models are feasible and acceptable, but the trials were often underpowered or limited by the severe baseline resource scarcity in the study settings.