Global Inequalities in Stroke Rehabilitation: System Capacity, Workforce, and Access in Low- and Middle-Income Countries

This review examines global inequalities in stroke rehabilitation in low- and middle-income countries (LMICs). It aims to identify key system-level determinants, including access to services, workforce capacity, financing, and policy frameworks—that contribute to disparities in post-stroke rehabilitation and long-term outcomes. Recent research demonstrates a growing mismatch between rehabilitation needs and service availability in LMICs. Persistent barriers include severe shortages of trained rehabilitation professionals, inadequate infrastructure, fragmented care pathways, and high out-of-pocket expenditures. Although task shifting, community-based rehabilitation, family-mediated therapy, and telerehabilitation have been introduced to mitigate these gaps, evidence for their scalability and sustained effectiveness remains heterogeneous. Stroke rehabilitation inequities in LMICs primarily reflect structural health system constraints rather than lack of therapeutic efficacy. Sustainable improvement requires integration of rehabilitation into universal health coverage, investment in workforce development, and strengthened post-acute care pathways. These findings highlight priorities for future implementation and health system research.