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Supply Chain Break For Medications in Physical and Rehabilitation Medicine: A Risk-based Framework for Preparedness
Ahmad J Abdulsalam1, Yousef Abdulsalam2, Mahmoud M El-Mas3,4
1Department of Physical Medicine and Rehabilitation, Mubarak Al-Kabeer Hospital, Jabriya, Kuwait.
American Journal of Physical Medicine & Rehabilitation
|August 11, 2026
Summary
Pharmaceutical supply chains are vulnerable, risking critical rehabilitation medications. A new risk matrix and contingency framework are proposed to address these disruptions and ensure patient safety.
Area of Science:
- Pharmacology
- Rehabilitation Medicine
- Supply Chain Management
Background:
- Pharmaceutical supply chains face increasing disruptions from global events.
- Rehabilitation pharmacotherapy is particularly vulnerable due to medication characteristics (narrow therapeutic windows, cold-chain needs, lack of substitutes).
- Interruption of core rehabilitation medications can lead to severe clinical consequences.
Purpose of the Study:
- To analyze vulnerabilities in key rehabilitation medication categories.
- To define and apply a stockout risk matrix for assessing pharmaceutical supply chain risks.
- To propose a contingency framework for managing medication supply disruptions.
Main Methods:
- Examined three rehabilitation medication categories: spasticity, pain/musculoskeletal, and neurorehabilitation agents.
- Developed and applied an expert-derived, literature-informed stockout risk matrix.
- Classified stockout risks based on likelihood (manufacturer concentration, logistics, lead time, price volatility) and clinical consequence severity (morbidity, substitutability, patient population size).
- Used the 2026 Strait of Hormuz crisis as a case illustration.
Main Results:
- Identified specific vulnerabilities within spasticity, pain/musculoskeletal, and neurorehabilitation medication supply chains.
- The stockout risk matrix effectively classified potential disruptions based on defined dimensions.
- The Strait of Hormuz crisis highlighted the real-world impact of geopolitical events on medication availability.
Conclusions:
- Pharmaceutical supply chain preparedness is an underdeveloped competency in Physical and Rehabilitation Medicine.
- A proactive contingency framework including strategic reserves, protocol switching, telerehabilitation, and mutual aid is essential.
- Addressing import dependence and disruption risks is crucial for ensuring consistent patient care in rehabilitation.
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