Strategies for improving access to stroke rehabilitation services in low and middle-income countries: Evidence from systematic reviews

Background: Therapeutic multidisciplinary stroke rehabilitation services have been shown to enhance recovery and reduce patient dependency in high-income countries (HICs). However, meeting the rehabilitation needs of stroke survivors in Low and Middle-Income Countries (LMICs), with limited rehabilitation resources, is a challenging task. With the rising incidence of stroke and inaccessibility to rehabilitation services in LMICs, it is imperative that we develop innovative strategies and rehabilitation interventions to improve access to stroke services in these countries. Method: Some of the strategies for improving access to stroke rehabilitation services in LMICs and the evidence for such strategies were systematically reviewed and discussed. These include Community-based Rehabilitation (CBR), Self-Management, Educational Interventions and mHealth Interventions. Existing evidence from the systematic review of any of these strategies was re-reviewed in greater detail. Results: We conducted a systematic review of CBR and Educational intervention strategies. We identified a systematic review and a meta-review of Mhealth and Self-management strategies respectively. Evidence from these reviews shows that each strategy has a beneficial effect on various stroke-related outcomes for the stroke survivors. Conclusion: In the absence of any organised stroke care services, and with the limited resources available for rehabilitation, a mHealth-enabled educational intervention for management of disabilities could be a strategy to meet the rehabilitation needs of stroke survivors in any LMICs. Adoption of this strategy could possibly reduce the barriers to access and availability of stroke rehabilitation services. It could also aid in efficient monitoring of patient progress throughout the continuum of care.