Introduction

Over the past decade, low- and middle-income countries (LMICs) have witnessed a 42% rise in stroke incidence. This is significantly higher than in high-income countries, contributing disproportionately to the global burden of disability-adjusted life years (DALYs) post stroke.1 This calls for an effective implementation of evidence-based interventions for stroke survivors, which is proven to improve quality of life.1,2

Motor rehabilitation, a subset of stroke rehabilitation, has been studied extensively in recent decades. It is defined “as a process that engages people with stroke to benefit their motor function, activity capacity and performance in daily life,” and is implemented using learning- and task-dependent mechanisms.3 Recognized as a critical component of the stroke rehabilitation pathway for individuals with movement deficits, it addresses both the ‘activity’ and ‘participation’ dimensions of the International Classification of Impairment, Disability, and Handicap model.3

Clinical practice guidelines (CPGs) are systematically developed recommendations that not only serve to guide practice but have been shown to improve clinical outcomes post-stroke, reduce healthcare costs, and improve clinical decision-making and healthcare delivery while guiding future research.4,5,6 This has been recommended as an essential step in the process of motor rehabilitation post-stroke by the European Stroke Organization (ESO). Despite its proven importance, many LMIC settings lack well-established stroke care pathways and capacities for optimal stroke care.7 However, its uptake by rehabilitation professionals in many countries is often limited due to various perceived barriers.8,9,10,11,12 The most perceived barriers from HICs are the time-consuming nature of CPG implementation and the limited skilled workforce, which lacks familiarity with recommended treatments.10,11 Among LMICs, the challenges are numerous and multifaceted, notably being the lack of awareness of existing stroke rehabilitation guidelines, compounded by the poorly developed CPGs lacking methodological rigor and context-specificity further resulting in poor clinical implementability.12 Most CPGs for stroke rehabilitation from LMICs fail to include relevant stakeholders during their development, fail to reach the relevant target audience, and are not contextually relevant to the users, failing to integrate sociocultural and economic considerations11,12,13.

The WHO’s 2023 report consolidated global CPGs for stroke rehabilitation using the ‘Appraisal of Guidelines for Research and Evaluation’ (AGREE) tool, included guidelines originated from HICs, except those from South Africa, without mentioning the process or the need to implement such evidence-based recommendations.13,14,15. In addition, Platz T 2019., noted that the large evidence base does not directly aid practice recommendations, leaving clinicians with questions regarding its implementation in clinical practice.14 These findings, highlighting the need for contextualization of existing CPGs for use in low-resource settings were reported in 2024 by the Global Consortium of Stroke rehabilitation-serving low-resource settings.15 Similarly, the Lancet Neurology Commission, with the World Stroke Organisation and the International Stroke Recovery and Rehabilitation Alliance, recommends contextualizing and implementing CPGs according to the regional needs to effectively practice Evidence-Based Practice (EBP).13

Implementing CPGs is a priority to optimise the quality of stroke rehabilitation delivery in LMICs. This would require understanding the gaps and user perspectives in the use of CPGs among rehabilitation professionals in these regions. The findings of this survey could then inform targeted solutions for better uptake of CPGs among rehabilitation professionals. Focusing on post-stroke motor rehabilitation, the survey aimed to explore the barriers to utilizing CPGs among rehabilitation professionals in LMICs. The paper explains the methodology, including the design and implementation of a questionnaire, data analysis, and results thereof.