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

Abstract: This review aimed to systematically identify and compare randomized controlled trials of poststroke upper extremity rehabilitation interventions conducted in low-middle-income countries and high-income countries 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. Randomized controlled trials were included if ≥50% of the study population had stroke, if participants were adults (≥18 yrs), and if the randomized controlled trial examined an intervention to the hemiparetic upper extremity. A total of 1276 randomized controlled trials met inclusion criteria, and of these, 978 randomized controlled trials were conducted in high-income countries and 298 in low-middle-income countries. The number of randomized controlled trials increased at a comparable rate to high-income countries since 2011 although from a lower baseline. A higher percentage of randomized controlled trials in high-income countries were conducted in the chronic poststroke phase, and a higher percentage of randomized controlled trials in low-middle-income countries were conducted in the subacute phase. While the randomized controlled trials in low-middle-income countries were found to have comparable quality to randomized controlled trials of high-income countries, they were published in aggregate in journals with lower impact factors. It is important to better understand the potential barriers to publication in higher impact journals for randomized controlled trials conducted in low-middle-income countries.