Integrated approaches to advancing rehabilitation in primary healthcare in Bangladesh: A narrative review

Findings from the LMICs, specially BRICS countries (Brazil, Russia, India, China, South Africa), are summarised and presented below (Table 1).

Chile's comprehensive approach

Health disorders that benefit from rehabilitation account for at least 50% of all disability-adjusted life years [14]. The WHO has identified Chile's 2004 pilot programme, which included rehabilitation services in PHC, as a practical example of removing obstacles to integrating PHC rehabilitation [14]. The Chilean Ministry of Health funded and implemented the Comprehensive Rehabilitation Programme in the Health Network in 2007, including the first Comprehensive Rehabilitation Programme in PHC (RehabPHC) as a major innovation [14].

RehabPHC uses three strategies to provide services: Rural rehabilitation teams, integrative rehabilitation rooms, and community rehabilitation rooms [14, 15]. Chile's 2004 pilot programme that successfully integrated rehabilitation into PHC has important implications for Bangladesh .

Among African countries Rwanda is another good example. Rwanda has been engaging community health data use tables that has led to wider population coverage [16, 17].

Table 1 Best practices in Chile and BRICS countries on technological innovations in rehabilitation within primary healthcare (PHC)

BRICS experience

The BRICS nations offer important insights for Bangladesh, as India's mHealth applications for physiotherapy [18, 19] and Brazil's community-oriented rehabilitation frameworks provide potential solutions, particularly in rural regions with limited access to healthcare [20, 21]. Some consider rehabilitation as a dynamic and complex notion that requires multidisciplinary cooperation to adapt to changing sociopolitical discourse that impacts disabled people [22]. The BRICS countries are implementing healthcare reforms to reach universal health coverage [23]. Community-based health professionals provide PHC services with limited training within the public health systems of these nations [24, 25]. In India Public–private partnerships integrate rehabilitation into primary health care, supported by mHealth apps for physiotherapy guidance and progress tracking, leading to improved adherence and patient monitoring; emphasizes scalable, low-cost mobile platforms [26, 27]. China integrated Rehabilitation into community health centres, using virtual reality and robotics-assisted therapies, resulting in effective post-stroke and musculoskeletal recovery and scalable tele-rehabilitation platforms [28, 29].

Exploding technology in rehabilitation

It marks a major change in how healthcare providers deliver rehabilitation treatments, leveraging digital tools, data-driven insights, and improved communication to enhance patient outcomes [30]. This paradigm shift affects diagnosis, treatment planning, therapy, data management, interdisciplinary collaboration, remote monitoring, and patient participation [31]. Findings are presented in Table 2.

Table 2 Technological advances in rehabilitation relevant to primary healthcare (PHC) in low- and middle-income countries

Telerehabilitation

Telemedicine has enabled medical experts to assess, diagnose, and treat patients in remote areas it includes remote patient monitoring, real-time video consultations, and digital platforms for doctor-patient communication [32]. Telerehabilitation, a branch of telemedicine, is the technique of remotely overseeing rehabilitation [33]. Multiple studies reported that telerehabilitation produced outcomes comparable to in-person therapy in stroke and musculoskeletal rehabilitation [34, 35, 36] with comparable patients satisfaction [37].

Key technologies

Neuropsychological rehabilitation simulates real-world events and creates compensating mechanisms through cognitive simulations and computerised examinations [38]. The "NeuroVR" system is a sophisticated technology that enhances flow and presence, empowering patients throughout rehabilitation [39]. Only platforms offer secure video conferencing for medical and educational consultations [40]. Wearable sensors Enable real-time tracking of motion, gait, and muscle activity, improving adherence and clinician monitoring [41, 42]. The mHealth apps Support patient education, reminders, and self-management, enhancing adherence in low-resource settings [43, 44]. Artificial intelligence tools: Enable personalized exercise recommendations and predictive outcomes, supporting precision rehabilitation [45– 47]

Robotics and assistive technology

Robotic technology may transform rehabilitation facilities and enhance patient outcomes by providing accurate, repetitive, and task-specific therapies [48]. Robotic technology, including exoskeletons, assisted training tools, and brain-computer interface systems, can promote patient autonomy and functional rehabilitation [49– 51]. One popular technique in rehabilitation, particularly for regaining motor abilities, is robotic mechanotherapy [52]. According to the study, robotic therapy may greatly enhance dexterity, strength, coordination, and motor function. Robotic gadgets also increase neuroplasticity by helping patients restore motor skills through frequent, precise, and regulated exercises. Additionally, home-based stroke rehabilitation uses robotic technologies to enable patients to participate in treatment outside clinical settings [53]. Robot-assisted arm training has shown potential to enhance post-stroke ADLs, arm function, and arm muscle strength [54]. Virtual reality and robot-assisted therapy are promising alternative treatments for motor function and quality of life. The computer-patient interface in virtual reality treatment simulates environmental interactions using hardware and software [55, 56]. This enables the development of sensory connections that closely resemble reality, with the additional advantages of instantaneous feedback and simultaneous task execution [57]. Robot-assisted therapy has shown potential to restore lost motor function or compensate for deficits after stroke [58].

Implementation barriers and facilitators

Implementation of telerehabilitation, VR, robotics and other digital tools is influenced by health system factors at multiple levels. Key barriers are poor infrastructure and connectivity, insecure or complex platforms, limited digital skills among providers and patients, higher perceived workload, and inadequate funding and reimbursement. At the policy level, scale‑up is constrained by weak integration of rehabilitation into national health systems, fragmented governance, and unclear legal and regulatory frameworks (e.g. data protection, liability). Facilitators include strong leadership and local “champions”, supportive national policies and financing for rehabilitation and assistive technologies, intersectoral collaboration, provider training and support, and technologies that are familiar, easy to use, and clearly beneficial to patients and professionals [59, 60].

Bangladesh-specific considerations

Rehabilitation services in Bangladesh are fragmented, urban-focused, and poorly integrated into PHC. The WHO's Rehabilitation 2030 Initiative is timely global initiative and relevant for improving service delivery. It addresses national health system constraints and growing rehabilitation needs through political leadership, integration into universal health coverage and PHC, workforce development, and scalable service models.

Current healthcare infrastructure

PHC infrastructure in urban and area should be described. The PHC is delivered in the urban areas primarily by city corporations and municipal facilities, such as urban primary health centres, ward level clinics, and NGO clinics with provision of basic outpatient care, MCH, immunization, family planning, and limited NCD care with referral to tertiary hospitals. Services are disjointed, with disability friendly infrastructure lacking, despite being better geographically available [61, 62].

PHC is structured in the rural setting in terms of community clinics, union health and family welfare centres, and upazila health complexes that provide 24/7 outpatient and inpatient services, as well as basic preventive/curative care, as referral centres. Despite a broad coverage, lack of trained personnel, rehabilitation, and disability inclusive infrastructure constrain effective access by people with disabilities [62, 63].

Over 20 million handicapped people live in Bangladesh, 10% of whom have major mobility, self-care, and daily life issues at home and work [64]. There has been much discussion over the prevalence of disability statistics. The estimated prevalence of disability is 14% [7]. Rural, elderly, and female residents have higher disability rates. Bangladesh Disability Classification includes autism, cerebral palsy, Down syndrome, multiple impairments, and physical, psychological, visual, verbal, intellectual, hearing, and hearing-visual diseases. Physical restrictions predominate (22.5%) [65].

Health bulletin Directorate General of Health Services 2017 shows 5.34 doctors per 10,000 and 93,763 registered physicians. The DGHS lists 5630 public and private hospitals with 137,024 beds. Metropolitan areas employ most doctors. Only 2.8% of earnings go to health care [66].

Community-based rehabilitation (CBR) initiatives like Bangladesh's Promotion of Human Rights of Persons with Disabilities combine mental health therapies. Stigma and accessibility remain issues [67].

Social businesses as long-term rehabilitation models have been studied. A rural Bangladesh case study showed how these models might provide early intervention and rehabilitation services, sustaining revenues beyond setup expenses [68]. This review suggests a five-stage model of enhancing rehabilitation services in Bangladesh based on synthesis of the global models and technological innovations (Table 3) . The Framework represents a five-phase strategic framework for integrating rehabilitation into Bangladesh's PHC system. The phases are: (I) Institutionalization of rehabilitation in PHC [15, 69, 70]; (II) Capacity and workforce development [21, 71, 72]; (III) Technological innovation through cost-effective digital tools [18, 26, 73, 74]; (IV) Implementation and nationwide scale-up [20, 26, 75, 76]; and (V) long-term sustainability through monitoring and evaluation [77, 78, 79, 80]. For each phase, the table lists strategic focus, key actions, core stakeholders (e.g., MoHFW, DGHS, universities, NGOs, ICT Division), expected outcomes, and potential challenges such as funding constraints, workforce migration, and digital literacy gaps.

Bangladesh could overcome problems such as limited access in rural areas and a shortage of workers by using strategies like Rural Rehabilitation Teams and Integrative Rehabilitation Rooms, especially in areas that don't get enough help.