When medical training amplifies therapeutic nihilism: a cross-national study of healthcare professional attitudes toward stroke recovery in Central Africa

Background: Healthcare professionals' beliefs about stroke recovery profoundly influence rehabilitation outcomes. While therapeutic pessimism has been documented in high-income countries, no study has quantified these attitudes in sub-Saharan Africa or examined their correlation with clinical practice patterns. Objective: To quantify therapeutic pessimism among Central African healthcare professionals using a validated assessment instrument and examine its relationship with rehabilitation intensity preferences and treatment discontinuation patterns. Methods: = 123). We developed and validated the Central Africa Stroke Beliefs Assessment Scale (CASBAS) and Rehabilitative Negativity Index (RNI, range 0-100) to quantify therapeutic attitudes during a standardized 2-month data collection period (November 2023-January 2024). Results: < 0.001). Systematic underestimation of optimal rehabilitation intensity was pervasive: 65-70% of healthcare professionals recommended 1-3 h/week despite neuroplasticity evidence supporting >10 h/week. These limiting beliefs correlated with premature treatment discontinuation (80% cessation within 3 months) and demonstrated a clear inverse relationship between professional training level and recovery expectations, revealing what we term "Rehabilitative Negativity Syndrome" (RNS). Conclusion: Central African healthcare professionals demonstrate systematic therapeutic pessimism substantially exceeding documented rates in high-income settings. The RNI provides the first validated quantitative framework for measuring these attitudes. Medical education paradoxically amplifies therapeutic nihilism, creating barriers to evidence-based intensive rehabilitation. These findings establish baseline data essential for targeted curriculum reform and suggest that professional pessimism may constitute a modifiable determinant of stroke outcomes.