Systematic Therapeutic Pessimism Among Healthcare Professionals in Cameroon and Central Africa: A Quantitative Assessment of Attitudes Toward Stroke Recovery

Abstract Background Stroke rehabilitation outcomes are significantly influenced by healthcare professionals' beliefs and expectations about recovery potential. In Central Africa, where stroke burden is increasing rapidly, little is known about healthcare professionals' attitudes toward post-stroke rehabilitation. While therapeutic pessimism has been documented in high-income countries, no study has systematically quantified these attitudes in sub-Saharan Africa nor demonstrated their correlation with clinical practice patterns. Objective To quantify for the first time the systematic pessimism among healthcare professionals in Central Africa using a validated assessment scale, and document its correlation with premature treatment discontinuation and suboptimal rehabilitation intensity preferences, examining how these beliefs may impact rehabilitation outcomes through systematic therapeutic negativity patterns. Methods A cross-sectional survey was conducted among healthcare professionals in Central Africa including physiotherapy students (n = 217), medical students (n = 197), practicing physiotherapists and specialists (n = 138), general practitioners and specialists (n = 101), and stroke survivors' families (n = 123). Participants were assessed using the newly developed Central Africa Stroke Beliefs Assessment Scale (CASBAS) during a standardized 2-month data collection period across six countries. Results This study provides the first quantitative evidence of systematic therapeutic pessimism across professional groups. While 40% of stroke families expected lifelong recovery potential, only 10% of medical students shared this belief. Systematic patterns of premature treatment expectations were evident in rehabilitation intensity preferences, with 65% of physiotherapy students recommending 1–3 hours/week, while only 15% recommended > 10 hours/week. Healthcare professionals demonstrated systematically lower expectations for recovery compared to evidence-based recommendations for intensive rehabilitation and stroke families' expectations. Conclusions Healthcare professionals in Central Africa demonstrate systematic limiting professional expectations about stroke recovery potential and favor low-intensity rehabilitation approaches. These findings represent the first systematic documentation of therapeutic attitudes in Central African stroke care, providing baseline data essential for developing targeted educational interventions. These limiting beliefs may constitute a significant barrier to optimal stroke rehabilitation outcomes and require urgent educational interventions.