Mobile Health for Post-Stroke Rehabilitation in Rural Uzbekistan: Can Apps Replace In-Person Physical Therapy?

Abstract

Background: Stroke is one of the leading causes of disability worldwide, and in rural Uzbekistan the situation is especially difficult — trained physiotherapists are almost entirely unavailable, leaving many stroke survivors with no rehabilitation support after leaving hospital. Mobile health (mHealth) apps have been proposed as a practical solution, but it is unclear how well they work in settings like rural Uzbekistan, where internet access is limited, digital literacy is low, and locally adapted tools are rare.

Methods: We conducted a narrative literature review following PRISMA-informed search principles to identify and synthesize existing research on mHealth apps for post-stroke rehabilitation in low- and middle-income countries (LMICs). We searched PubMed, Embase, and Google Scholar. Of approximately 80 articles screened, 9 studies (including 2 systematic reviews/meta-analyses) most directly addressed mHealth effectiveness, barriers, and facilitators in LMIC stroke populations and were selected for detailed synthesis. The Technology Acceptance Model (TAM), Health Belief Model (HBM), and Diffusion of Innovations (DOI) theory were used to interpret findings.

Results: The reviewed evidence, published between 2018 and 2024 and drawn from China, Ghana, Spain, Malaysia, and multi-country meta-analyses, shows the strongest support for upper limb motor recovery. One meta-analysis found a significant improvement in Fugl-Meyer scores (MD 9.81, 95% CI 8.72 to 10.90, p<0.00001) in app users compared to controls. However, improvements in daily living independence (Barthel Index) and balance (Berg Balance Scale) were not significant in pooled analyses. Adherence was generally high when human support was present alongside the app. The most consistently reported barriers were low digital literacy, poor internet connectivity, device affordability, and lack of apps in local languages. The most consistently reported facilitators were family involvement, clinician or nurse check-ins, simple app design, and community health worker support.

Conclusion: mHealth apps show genuine promise for improving upper limb function after stroke in LMICs, but their impact on daily living and balance is less certain. In a country like Uzbekistan where many rural patients receive no rehabilitation at all, even these partial benefits are meaningful. Success depends on human support, local language adaptation, and offline functionality. Primary research conducted directly in Uzbekistan, alongside investment in locally designed apps and community health worker training, is urgently needed.