Physiotherapist-Led Stroke Rehabilitation in India: Preliminary Results from the Karnataka Brain Health Initiative (KaBHI) Model

Abstract Background Post-stroke disability contributes substantially to long-term functional limitation, yet access to rehabilitation remains inequitable in low and middle-income countries (LMICs), where workforce and service delivery constraints are pronounced. Global priorities, including WHO’s Rehabilitation 2030 agenda, emphasize integrating scalable rehabilitation into health systems and decentralizing services beyond tertiary-centers. Evidence supports home and community-oriented approaches, including caregiver-mediated exercise, that can achieve gains comparable to centre-based therapy when dose is matched. The Karnataka Brain Health Initiative (KaBHI) is a public-sector model strengthening neurological care pathways through district Brain Health Clinics (BHCs). Objective To evaluate short-term changes in balance, mobility, and global disability among community-dwelling stroke survivors completing the KaBHI physiotherapy programme. Methods This prospective, single-group pre–post evaluation included adults aged 18–90 years enrolled at KaBHI BHCs (April–December 2024). Participants received a structured six-week balance and mobility programme prescribed by physiotherapists and implemented with caregiver support and follow-up within routine-care. Outcomes assessed at baseline (day 0) and post-intervention (day 45) were the Berg Balance Scale (BBS), Timed Up and Go (TUG), and Modified Rankin Scale (mRS). Results Among 199 participants (mean age 54.9 ± 14.5 years; 71% male), BBS improved from 28.9 to 37.2 (p < 0.001), TUG improved from 22.7 s to 19.8 s (p < 0.001), and mRS decreased from 3.30 to 2.45 (p < 0.001). Clinically meaningful improvement was common: 51% achieved ≥7-point gains on BBS, and 70% improved by ≥1 mRS grade. No programme-related serious adverse events were reported. Conclusions In a real-world public health setting, a physiotherapist-led, caregiver-supported KaBHI rehabilitation model delivered through district BHCs demonstrated significant short-term improvements in balance, mobility, and disability. These findings align with evidence supporting decentralized, home-/community-oriented, caregiver-mediated rehabilitation and support KaBHI as a potentially scalable strategy to strengthen stroke rehabilitation capacity in resource-constrained settings; controlled and longer-term evaluations are warranted.