Continuing professional development to strengthen stroke rehabilitation: learning outcomes from Myanmar

Stroke is the second leading cause of global disability with the majority of stroke-related disabilities occurring in low- and middle-income countries. In Myanmar, ongoing political instability and healthcare disruption have further limited access to stroke rehabilitation services. This study evaluated a contextually tailored continuing professional development program designed to strengthen evidence-based stroke rehabilitation knowledge, skills, and clinical implementation among physiotherapists in Myanmar.

This mixed methods, quasi-experimental study used convenience sampling to recruit rehabilitation professionals participating in a blended learning stroke rehabilitation program in Myanmar. The program combined online coursework, synchronous mentoring, and in-person clinical skills training. Training effectiveness was evaluated using the Kirkpatrick Model across the domains of reaction, learning, behavior, and results. Participants completed pre-training, post-online, post-in-person, and six-month follow-up surveys assessing self-perceived knowledge, skills, and implementation of evidence-based stroke rehabilitation techniques. Quantitative data were analyzed using Kruskal-Wallis and Mann-Whitney U tests with Bonferroni correction. Focus group interviews were conducted six months following training and analyzed using thematic analysis. Quantitative and qualitative findings were integrated during interpretation to better understand implementation within the Myanmar context. Ethical approval was obtained from the Johns Hopkins Bloomberg School of Public Health Institutional Review Board.

Seventeen rehabilitation professionals participated in the online training and 16 physiotherapists completed the in-person clinical skills component. Seven participants participated in focus group interviews six months later. Participants demonstrated significant improvements in self-perceived knowledge and skills related to evidence-based stroke rehabilitation, particularly for interventions requiring minimal equipment. Follow-up surveys indicated integration of evidence-based assessment and treatment approaches into clinical practice. Qualitative findings contextualized these changes and identified four themes: challenges in rehabilitation perception, need for enhanced training in fine motor skills, resourceful adaptation of techniques for low-resource settings, and the importance of a learning community. Integrated findings demonstrated that participants adapted evidence-based rehabilitation concepts using locally available resources and peer support networks.

Contextualized training approaches emphasizing adaptability, peer learning, and resource-conscious implementation may support the application of evidence-based stroke rehabilitation practices in LMICs affected by workforce and health system constraints.