Bridging the gap: unique strategies to improve access and implementation of stroke rehabilitation in LMICs–a scoping review

Purpose: The demand for stroke rehabilitation is rising across Low- and Middle-Income Countries (LMICs). This review explores the determinants affecting access to and utilization of post-stroke physical rehabilitation in LMICs. Material and Methods: A systematic literature search across multiple databases retrieved 463 articles, of which 35 studies included were from Asia, Africa, and South America met the inclusion criteria. During the review process, 2 additional relevant studies were identified and added. A descriptive synthesis was conducted to identify key determinants influencing rehabilitation access and use. Results: Three major categories of determinants emerged: (1) Contextual factors, including traditional/spiritual beliefs, reliance on alternative medicine, gender disparities, poor awareness, and environmental barriers; (2) Personal factors, such as apathy toward rehabilitation, lack of clinical guidance, and psychological challenges (fatigue, depression, cognitive impairment); (3) Resource-related factors, including high out-of-pocket costs, low provider pay, insufficient infrastructure, inadequate health policies, limited professional training, and poor rehabilitation curricula. Recommendations focus on capacity building, service delivery, extended support, and treatment content. Conclusion: LMICs face unique, context-specific challenges in stroke rehabilitation, requiring tailored solutions. Addressing these barriers necessitates region-specific strategies that align with health system structures, governmental policies, economic resources, professional education, and clinical practice guidance.