When medical training amplifies therapeutic nihilism: a cross-national study of healthcare professional attitudes toward stroke recovery in Central Africa

Abstract

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.