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

Background: A better understanding of the overall picture of post-stroke motor trials in relation to country resources can be an important step to further understand potential disparities.

Objective: To characterize randomized controlled trials (RCTs) of interventions for the rehabilitation of post-stroke lower extremity (LE) motor disorders, conducted in high-income countries (HICs) and in low-to-middle-income countries (LMICs).

Methods: Systematic searches of RCTs in English were conducted in MEDLINE, Embase, CINAHL and PsycINFO, up to December 2024, according to the Preferred Reporting Items for Systematic reviews and Meta Analyses (PRISMA).

Results: A total of 1,577 RCTs met inclusion criteria. RCTs from LMICs have accelerated after 2014 and surpassed HICs on an annual basis after 2022. Most RCTs in HICs were conducted in the chronic phase post-stroke compared to LMICs (p < 0.001). 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) were more likely to be examined in HICs, while acupuncture (p < 0.001), task-specific training (p = 0.03), neurodevelopmental techniques (p = 0.03), and mirror therapy (p = 0.04) were more likely to be examined in LMICs. A higher percentage of RCTs in HICs (28%) were published in journals with an impact factor of >3, compared to LMICs (18.4%), despite similar quality indicators and larger sample sizes in LMICs.

Conclusion: The number of RCTs from LMICs has surpassed HICs on an annual basis after 2022. RCTs from LMICs are more often published in journals with lower JIF, despite similar quality. Interventions studied were similar, challenging broad assumptions about LMICs evaluating less costly interventions.