Characteristics of randomized controlled trials of lower extremity interventions for post-stroke recovery in low-to-middle-income countries and high-income countries.

Researchers analyzed 1,577 studies on treatments for leg and walking problems after stroke, comparing research conducted in high-income countries versus low-to-middle-income countries. The study found interesting patterns in what types of treatments are being researched in different parts of the world. In wealthier countries, researchers focused more on technology-based treatments like robotic training, treadmill training, and computerized feedback systems. These studies were also more likely to examine people in the chronic phase of stroke recovery (more than six months after stroke). In contrast, low-to-middle-income countries conducted more research on acupuncture, task-specific training, mirror therapy, and neurodevelopmental techniques. Surprisingly, the research from lower-income countries often included larger numbers of participants and showed similar scientific quality to studies from wealthier nations, yet tended to be published in lower-ranked medical journals. Since 2022, low-to-middle-income countries have actually been producing more stroke rehabilitation studies annually than high-income countries, challenging assumptions about research capacity. For stroke survivors considering acupuncture as part of their rehabilitation, this study confirms that acupuncture is being actively researched and studied in clinical trials, particularly in countries where it is more commonly integrated into standard medical care. The findings suggest that effective rehabilitation options may include both technology-based approaches and traditional methods like acupuncture, depending on availability and individual patient needs. If considering acupuncture for post-stroke recovery, seek a licensed acupuncturist with experience treating neurological conditions.

This systematic review analyzed 1,577 RCTs investigating lower extremity motor rehabilitation interventions post-stroke, comparing trials from high-income countries (HICs) versus low-to-middle-income countries (LMICs). Searches were conducted in MEDLINE, Embase, CINAHL, and PsycINFO through December 2024 following PRISMA guidelines. Key findings reveal that LMIC-based RCTs have exceeded HIC output annually since 2022. Significant intervention differences emerged: HICs favored robotic training (p=0.002), gait training (p=0.000), treadmill training (p<0.001), feedback training (p=0.01), and rhythmic-auditory training (p=0.03), while LMICs significantly favored acupuncture (p<0.001), task-specific training (p=0.03), neurodevelopmental techniques (p=0.03), and mirror therapy (p=0.04). HICs conducted more chronic-phase studies (p<0.001). Despite comparable methodological quality indicators and larger sample sizes in LMICs, only 18.4% of LMIC trials were published in journals with impact factors >3, compared to 28% from HICs. Clinical takeaway: Acupuncture represents a frequently studied intervention in LMIC stroke rehabilitation research, challenging assumptions about cost-based intervention selection.