Comparing the Characteristics of Randomized Controlled Trials of Post-Stroke Upper Extremity Rehabilitation in Low-Middle-Income and High-Income Countries.

Abstract: This review aimed to systematically identify and compare randomized controlled trials (RCTs) of post stroke upper extremity (UE) rehabilitation interventions conducted in low-middle-income countries (LMICs) and high-income countries (HICs) over time and their differences in study characteristics and quality. Searches were conducted in CINAHL, Embase, PubMed, Scopus and Web of Science up to April 1, 2021. RCTs were included if ≥50% of the study population had stroke, if participants were adults (≥18 yr), and if the RCT examined an intervention to the hemiparetic UE. 1,276 RCTs met inclusion criteria, and of these, 978 RCTs were conducted in HICs and 298 in LMICs. The number of RCTs increased at a comparable rate to HICs since 2011 although from a lower baseline. A higher percentage of RCTs in HICs were conducted in the chronic post stroke phase, and a higher percentage of RCTs in LMICs were conducted in the subacute phase. While the RCTs in LMICs were found to have comparable quality to RCTs of HICs, they were published in aggregate in journals with lower IFs. It is important to better understand the potential barriers to publication in higher impact journals for RCTs conducted in LMICs.