{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T00:23:30Z","timestamp":1790727810290,"version":"4.1.0"},"reference-count":56,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,4,22]],"date-time":"2026-04-22T00:00:00Z","timestamp":1776816000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Healthcare professionals\u2019 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      Cross-sectional survey of 776 participants across six Central African countries: physiotherapy students (\n                      <jats:italic>n<\/jats:italic>\n                      \u202f=\u202f217), medical students (\n                      <jats:italic>n<\/jats:italic>\n                      \u202f=\u202f197), physiotherapy specialists (\n                      <jats:italic>n<\/jats:italic>\n                      \u202f=\u202f138), physicians (\n                      <jats:italic>n<\/jats:italic>\n                      \u202f=\u202f101), and stroke families (\n                      <jats:italic>n<\/jats:italic>\n                      \u202f=\u202f123). We developed and validated the Central Africa Stroke Beliefs Assessment Scale (CASBAS) and Rehabilitative Negativity Index (RNI, range 0\u2013100) to quantify therapeutic attitudes during a standardized 2-month data collection period (November 2023\u2013January 2024).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Medical students demonstrated severe therapeutic nihilism (mean RNI\u202f=\u202f78.3\u202f\u00b1\u202f12.4) with only 10% expecting lifelong recovery potential, contrasting sharply with stroke families (mean RNI\u202f=\u202f31.2\u202f\u00b1\u202f18.7, 40% expecting lifelong recovery,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.001). Systematic underestimation of optimal rehabilitation intensity was pervasive: 65\u201370% of healthcare professionals recommended 1\u20133\u202fh\/week despite neuroplasticity evidence supporting &amp;gt;10\u202fh\/week. These limiting beliefs correlated with premature treatment discontinuation (80% cessation within 3\u202fmonths) and demonstrated a clear inverse relationship between professional training level and recovery expectations, revealing what we term \u201cRehabilitative Negativity Syndrome\u201d (RNS).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2026.1795929","type":"journal-article","created":{"date-parts":[[2026,4,22]],"date-time":"2026-04-22T04:39:15Z","timestamp":1776832755000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":5,"title":["When medical training amplifies therapeutic nihilism: a cross-national study of healthcare professional attitudes toward stroke recovery in Central Africa"],"prefix":"10.3389","volume":"13","author":[{"given":"Ibrahim","family":"Npochinto Moumeni","sequence":"first","affiliation":[{"name":"Department of Physical Therapy and Physical Medicine, Faculty of Medicine and Pharmaceutical Sciences, University of Dschang","place":["Dschang, West Region, Cameroon"]},{"name":"Department of Physical Medicine and Osteopathy, Regional Hospital of Bafoussam","place":["Bafoussam, West Region, Cameroon"]},{"name":"Institute for Applied Neurosciences and Functional Rehabilitation (INAREF)","place":["Odza-Yaound\u00e9, Cameroon"]},{"name":"Franco-African Center for Applied Rehabilitation and Health Sciences (CFARASS)","place":["Foumbot, West Region, Cameroon"]},{"name":"Department of Geriatrics and Gerontology, Sorbonne Universit\u00e9, Piti\u00e9-Salp\u00eatri\u00e8re Hospital","place":["Paris, France"]},{"name":"Licensed Physiotherapy Practitioner","place":["Paris, France"]},{"name":"Faculty of Health Sciences, University of Parakou","place":["Parakou, Benin"]},{"name":"French-Speaking African Society for Neurorehabilitation (SAFNeR)","place":["Parakou, Benin"]},{"name":"UREKIM \u2013 Research Unit in Physiotherapy and Physical Medicine, Faculty of Medicine and Pharmaceutical Sciences, University of Dschang","place":["Dschang, West Region, Cameroon"]},{"name":"Faculty of Medicine and Pharmaceutical Sciences, Centre de Recherche en Sant\u00e9 Humaine et D\u00e9veloppement des M\u00e9dicaments (CRESHDEM), University of Dschang","place":["Dschang, West Region, Cameroon"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdel-Nasser","family":"Njikam Moumeni","sequence":"additional","affiliation":[{"name":"Department of Physical Medicine and Osteopathy, Regional Hospital of Bafoussam","place":["Bafoussam, West Region, Cameroon"]},{"name":"Institute for Applied Neurosciences and Functional Rehabilitation (INAREF)","place":["Odza-Yaound\u00e9, Cameroon"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bristher Orlister","family":"Tchuidjio Ketchogu\u00e9","sequence":"additional","affiliation":[{"name":"Department of Physical Medicine and Osteopathy, Regional Hospital of Bafoussam","place":["Bafoussam, West Region, Cameroon"]},{"name":"Institute for Applied Neurosciences and Functional Rehabilitation (INAREF)","place":["Odza-Yaound\u00e9, Cameroon"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Temgoua","sequence":"additional","affiliation":[{"name":"Institute for Applied Neurosciences and Functional Rehabilitation (INAREF)","place":["Odza-Yaound\u00e9, Cameroon"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yacouba","family":"Njankouo Mapoure","sequence":"additional","affiliation":[{"name":"Faculty of Medicine and Biomedical Sciences, University of Douala","place":["Douala, Cameroon"]},{"name":"Head of Department of Internal Medicine \u2013 Neurology, Douala General Hospital","place":["Douala, Cameroon"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,4,22]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"795","DOI":"10.1016\/S1474-4422(21)00252-0","article-title":"Global, regional, and national burden of stroke and its risk factors, 1990\u20132019: a systematic analysis for the 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