Abstract Body: Introduction: Stroke is the second leading cause of death and third leading cause of disability among non-communicable diseases. Rehabilitation is vital in restoring motor function and independence, and caregivers are essential to this process. Compared to high income countries, low- and middle-income countries (LMICs) have conducted limited studies on the needs of stroke survivors and caregivers. The aim of this study is to understand the barriers and facilitators that impact access to and utilization of rehabilitation services in coastal Karnataka, India.
Methods: This cross-sectional study used two questionnaires, the Indian Stroke Scale and an internally validated questionnaire. Stroke survivors who were 18 years or older, experienced one or more ischemic or hemorrhagic strokes 6 months to 36 months prior to enrollment, and were admitted to Kasturba Hospital in Manipal were included. Caregivers of eligible stroke survivors were included. Matched pair recruitment was not always feasible. This study included 54 stroke survivors and 51 caregivers. Data from both cohorts was analyzed separately using descriptive statistics.
Results: Among stroke survivors, 41 (76%) were male with an average age of 58.4 years (SD: 13.9). For most participants (65%), their spouse served as the primary caregiver, and the majority (76%) lived in rural areas. Following hospital admission, only 59% of stroke survivors participated in physical therapy, and 15% were receiving physical therapy at the time of the study. Among caregivers, 26 (51%) were male with an average age of 42.9 years (SD: 10.7). Awareness of stroke symptoms prior to hospitalization was low, with only 6 stroke survivors (11%) and 8 caregivers (16%) reporting prior knowledge. For both groups, family support was the most prevalent facilitator to rehabilitation care. Barriers included lack of reliable transport (stroke survivors), long waiting room times (caregivers) and cost of care (caregivers).
Conclusion: Stroke rehabilitation remains markedly underutilized in this population, and caregivers showed low awareness of stroke symptoms, which can contribute to delayed recognition of stroke. Strengthening post-discharge counseling, community-based rehabilitation, and caregiver education could improve long-term outcomes for stroke survivors in LMIC settings. Future studies should evaluate scalable interventions that enhance rehabilitation continuity and caregiver preparedness.