QUALITY AND ACCESSIBILITY OF REHABILITATION IN OBLITERATING ATHEROSCLEROSIS OF THE LOWER EXTREMITY ARTERIES: A...

Obliterating atherosclerosis of the lower extremity arteries (OALEA) is a major cause of morbidity and disability, requiring not only pharmacological and surgical treatment but also structured rehabilitation. Despite international guidelines emphasizing supervised rehabilitation as a key element of care, little is known about physicians' perspectives on its accessibility and quality in Kazakhstan. Aim to evaluate physicians' educational needs, practices, and perceived barriers to rehabilitation in OALEA.

A cross-sectional survey was conducted among 217 physicians who met the inclusion criteria and completed a structured questionnaire. Respondents included general practitioners (75.1%, N=163), surgeons (17.1%, N=37), and vascular surgeons (7.8%, N=17). Descriptive and comparative statistical analyses were performed, with chi-square tests applied to assess differences between groups.

The majority of respondents were female (67.7%) with a mean age of 38±11.1 years. Significant associations were observed between specialty and work experience (p=0.05), as well as between specialty and medical category (p = 0.001). Most physicians reported professional development once every five years, while one-third trained annually. General practitioners demonstrated the highest engagement in conferences (52.8%), whereas vascular surgeons preferred advanced courses (70.6%) (p=0.027; p=0.03). Barriers included lack of time among general practitioners (73.6%) and financial constraints among surgeons (54.1%) and vascular surgeons (58.8%) (p<0.001). Patient-related barriers were also identified: low adherence (47.2%), harmful habits (47.1%), and poor organization of rehabilitation (up to 58.8%). Almost all physicians (92-100%) supported the creation of vascular schools for patient education.

Physicians in Kazakhstan recognize the importance of rehabilitation in OALEA but face systemic and patient-level barriers that limit its implementation. Expanding supervised rehabilitation programs, introducing vascular schools, and enhancing physician training could significantly improve outcomes. Alignment with international standards should be prioritized in national healthcare strategies.