International Journal For Multidisciplinary Research

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Volume 8 Issue 2
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The Rehabilitation Care Gap: Coping Strategies and Unmet Needs Among Zambian Stroke Survivors Following COVID-19 Service Disruptions

Author(s) Ms. Mujilowe Patricia Ndhlovu, Prof. Dr. Esther Munalula Nkandu, Brian Chanda Chiluba
Country Zambia
Abstract Background: The COVID-19 pandemic triggered unprecedented disruptions in healthcare delivery worldwide, with particularly severe consequences for chronic disease management in low-resource settings. For stroke survivors whose functional recovery depends on consistent, supervised rehabilitation, these disruptions created critical challenges in maintaining therapeutic continuity and preventing functional decline.
Objective: This study aimed to characterize the coping strategies adopted by stroke survivors in Lusaka, Zambia, following disruptions to routine physiotherapy services during the COVID-19 pandemic, and to systematically analyze the resultant “care gap” and unmet clinical needs that emerged from this health system shock.
Methods: A cross-sectional mixed-methods study was conducted with 26 chronic stroke survivors purposively recruited from six referral hospitals in Lusaka. Data were collected via structured, researcher-administered questionnaires capturing detailed service attendance patterns, self-initiated management strategies, resource utilization, and access to alternative support systems. Descriptive and inferential statistics were computed, and qualitative content analysis using a framework approach was applied to open-ended responses to characterize adaptive behaviors, limitations, and health system failure points.
Results: A substantial multidimensional care gap was identified. Quantitatively, pre-pandemic attendance of 2-3 sessions weekly (76.9%, n=20) collapsed to 15.4% (n=4) during the pandemic, with most patients (61.5%, n=16) reduced to once-weekly sessions. Qualitatively, the primary coping strategy was a self-directed shift to unsupervised home exercises (76.9%, n=20), but only 15.4% (n=4) received specific, updated home-exercise instructions from their physiotherapist during this transition period. Systemic support was notably absent, with 73.1% (n=19) reporting no remote follow-up from healthcare providers. Thematic analysis revealed three core domains of unmet needs: (1) Technical deficits (absent hands-on correction, limited equipment access), (2) Knowledge gaps (uncertainty about exercise progression and safety), and (3) Psychosocial vulnerabilities (diminished motivation, therapeutic isolation).
Conclusion: Stroke survivors responded to service disruptions through predominantly unsupported, self-managed adaptations that exposed significant limitations in health system crisis responsiveness. The care gap that emerged was characterized not merely by reduced service volume but by a fundamental breakdown in the therapeutic alliance and continuity of care. Thus, the urgent necessity for healthcare systems in resource-limited settings is needed to develop proactive, structured self-management protocols, integrate low-tech remote support mechanisms, and formalize rehabilitation continuity plans that can maintain therapeutic engagement during public health crises.
Keywords Stroke Rehabilitation, COVID-19, Healthcare Disruptions, Coping Strategies, Health Systems Resilience
Field Medical / Pharmacy
Published In Volume 8, Issue 2, March-April 2026
Published On 2026-03-13
DOI https://doi.org/10.36948/ijfmr.2026.v08i02.67097
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