Frontiers in medicine · 2026
When medical training amplifies therapeutic nihilism: a cross-national study of healthcare professional attitudes toward stroke recovery in Central Africa.
СтатьяНазвание и аннотация: Перевод в очереди
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Npochinto Moumeni Ibrahim, Njikam Moumeni Abdel-Nasser, Tchuidjio Ketchogué Bristher Orlister, Temgoua Michael, Njankouo Mapoure Yacouba
Аннотация
BACKGROUND: Healthcare professionals' beliefs about stroke recovery profoundly influence rehabilitation outcomes. While therapeutic pessimism has been documented in high-income countries, no study has quantified these attitudes in sub-Saharan Africa or examined their correlation with clinical practice patterns.
OBJECTIVE: To quantify therapeutic pessimism among Central African healthcare professionals using a validated assessment instrument and examine its relationship with rehabilitation intensity preferences and treatment discontinuation patterns.
METHODS: Cross-sectional survey of 776 participants across six Central African countries: physiotherapy students (n = 217), medical students (n = 197), physiotherapy specialists (n = 138), physicians (n = 101), and stroke families (n = 123). We developed and validated the Central Africa Stroke Beliefs Assessment Scale (CASBAS) and Rehabilitative Negativity Index (RNI, range 0-100) to quantify therapeutic attitudes during a standardized 2-month data collection period (November 2023-January 2024).
RESULTS: Medical students demonstrated severe therapeutic nihilism (mean RNI = 78.3 ± 12.4) with only 10% expecting lifelong recovery potential, contrasting sharply with stroke families (mean RNI = 31.2 ± 18.7, 40% expecting lifelong recovery, p < 0.001). Systematic underestimation of optimal rehabilitation intensity was pervasive: 65-70% of healthcare professionals recommended 1-3 h/week despite neuroplasticity evidence supporting >10 h/week. These limiting beliefs correlated with premature treatment discontinuation (80% cessation within 3 months) and demonstrated a clear inverse relationship between professional training level and recovery expectations, revealing what we term "Rehabilitative Negativity Syndrome" (RNS).
CONCLUSION: Central African healthcare professionals demonstrate systematic therapeutic pessimism substantially exceeding documented rates in high-income settings. The RNI provides the first validated quantitative framework for measuring these attitudes. Medical education paradoxically amplifies therapeutic nihilism, creating barriers to evidence-based intensive rehabilitation. These findings establish baseline data essential for targeted curriculum reform and suggest that professional pessimism may constitute a modifiable determinant of stroke outcomes.
OBJECTIVE: To quantify therapeutic pessimism among Central African healthcare professionals using a validated assessment instrument and examine its relationship with rehabilitation intensity preferences and treatment discontinuation patterns.
METHODS: Cross-sectional survey of 776 participants across six Central African countries: physiotherapy students (n = 217), medical students (n = 197), physiotherapy specialists (n = 138), physicians (n = 101), and stroke families (n = 123). We developed and validated the Central Africa Stroke Beliefs Assessment Scale (CASBAS) and Rehabilitative Negativity Index (RNI, range 0-100) to quantify therapeutic attitudes during a standardized 2-month data collection period (November 2023-January 2024).
RESULTS: Medical students demonstrated severe therapeutic nihilism (mean RNI = 78.3 ± 12.4) with only 10% expecting lifelong recovery potential, contrasting sharply with stroke families (mean RNI = 31.2 ± 18.7, 40% expecting lifelong recovery, p < 0.001). Systematic underestimation of optimal rehabilitation intensity was pervasive: 65-70% of healthcare professionals recommended 1-3 h/week despite neuroplasticity evidence supporting >10 h/week. These limiting beliefs correlated with premature treatment discontinuation (80% cessation within 3 months) and demonstrated a clear inverse relationship between professional training level and recovery expectations, revealing what we term "Rehabilitative Negativity Syndrome" (RNS).
CONCLUSION: Central African healthcare professionals demonstrate systematic therapeutic pessimism substantially exceeding documented rates in high-income settings. The RNI provides the first validated quantitative framework for measuring these attitudes. Medical education paradoxically amplifies therapeutic nihilism, creating barriers to evidence-based intensive rehabilitation. These findings establish baseline data essential for targeted curriculum reform and suggest that professional pessimism may constitute a modifiable determinant of stroke outcomes.