Community-Based Rehabilitation and Physiotherapy: A Complete Evidence-Based Guide
Introduction: When Rehabilitation Has to Leave the Clinic
Imagine a man recovering from a stroke.
He has improved considerably in the hospital. He can stand with support, walk a few metres with a walker, and move his affected arm better than before. His physiotherapist gives him exercises and explains that regular practice is important.
Then he goes home.
There are no parallel bars.
There is no treadmill.
There is no sophisticated electrical stimulation machine.
The bathroom is several metres away, the floor is uneven, his family is unsure how much assistance to provide, and the nearest rehabilitation centre requires a long journey.
In the clinic, he may appear to be making progress.
At home, however, he may still be unable to safely use the toilet, cross the road, return to work, participate in family activities, or walk to the local shop.
This is where community-based rehabilitation (CBR) becomes important.
Community-based rehabilitation is not simply "physiotherapy at home." It is a broader approach that aims to improve the functioning, participation, inclusion, independence, and quality of life of people with disabilities by working with individuals, families, communities, health services, and other sectors.
The World Health Organization (WHO), together with ILO, UNESCO and disability organizations, developed the CBR Guidelines around this broader concept. The framework includes health, education, livelihood, social participation, and empowerment rather than focusing only on impairment or medical treatment. (World Health Organization)
For physiotherapists, this changes the question from:
"Can the patient move better?"
to:
"Can the person use that movement to live the life they want within their real environment?"
That difference is at the heart of community-based rehabilitation.
What Is Community-Based Rehabilitation?
Community-Based Rehabilitation (CBR) is a community-level strategy for promoting rehabilitation, inclusion, participation, empowerment, and quality of life for people with disabilities.
CBR aims to use available community resources while connecting people to specialized services when those services are required.
According to the WHO CBR framework, rehabilitation is only one part of a much broader system. The five major components are:
Health
Education
Livelihood
Social
Empowerment
The framework was developed specifically to encourage participation and inclusion rather than treating disability solely as a medical problem. (World Health Organization)
CBR is therefore bigger than physiotherapy.
A physiotherapist may contribute to CBR through mobility training, exercise, prevention of secondary complications, assistive-device training, caregiver education, and referral.
But successful CBR may also involve:
occupational therapists
speech and language therapists
physicians
nurses
community health workers
educators
social workers
vocational rehabilitation professionals
disability organizations
family members
local community leaders
people with disabilities themselves
Community-Based Rehabilitation vs Community Physiotherapy
These terms are related but not identical.
| Community-based rehabilitation | Community physiotherapy |
|---|---|
| Broad rehabilitation and inclusion strategy | Physiotherapy service delivered in the community |
| Includes health, education, livelihood, social and empowerment domains | Primarily focuses on physical function and movement |
| Multisectoral | Primarily physiotherapy-led |
| Strong emphasis on participation and inclusion | Strong emphasis on physical rehabilitation |
| May involve community development | May involve home visits, community clinics or outreach |
| Person with disability and community are active participants | Physiotherapist provides assessment and intervention |
Therefore:
Community physiotherapy can be a component of CBR, but CBR is not simply community physiotherapy.
Why Is Community-Based Rehabilitation Needed?
Traditional rehabilitation can be highly effective, but access is not equal.
People living in rural areas, economically disadvantaged communities, remote locations, or areas with limited rehabilitation infrastructure may face barriers such as:
transportation difficulties
treatment costs
lack of rehabilitation professionals
long distances to hospitals
inaccessible buildings
limited caregiver support
lack of awareness
social stigma
poverty
lack of assistive devices
inadequate follow-up
educational barriers
employment barriers
CBR attempts to address these barriers by bringing rehabilitation closer to people's everyday lives and connecting community resources with specialized services.
WHO describes the health component of CBR as promoting rehabilitation activities at community level while facilitating referral to specialized rehabilitation services when necessary. (Iris)
The Philosophy Behind CBR
Community-based rehabilitation is built around several important principles.
1. Participation
The person should not simply receive rehabilitation.
They should participate in deciding:
their goals
priorities
treatment plans
daily activities
community involvement
future plans
The person's goals may be very different from the therapist's goals.
A physiotherapist may prioritize improving knee extension.
The patient may prioritize:
"I want to walk to the mosque."
Both are important, but the second describes meaningful participation.
2. Empowerment
CBR aims to increase the ability of people with disabilities and their families to make decisions and access opportunities.
Empowerment may involve:
self-management education
disability awareness
advocacy
peer support
community participation
access to education
employment opportunities
access to assistive technology
participation in decision-making
The WHO CBR framework specifically emphasizes empowerment of people with disabilities and their families. (World Health Organization)
3. Inclusion
Rehabilitation should not end when the patient leaves the treatment room.
The ultimate objective is often participation in:
family life
education
employment
sports
religious activities
social events
community organizations
recreational activities
A person may have excellent muscle strength but still experience significant disability if the environment prevents participation.
4. Accessibility
Services should be as accessible as possible.
This may require:
community clinics
home visits
outreach programmes
tele-rehabilitation where appropriate
community health workers
transportation support
referral systems
assistive devices
caregiver education
5. Use of Local Resources
CBR does not necessarily require expensive technology.
A physiotherapist may use:
chairs
stairs
walls
walking paths
household objects
locally available exercise equipment
community spaces
family members
existing healthcare workers
The objective is not to recreate a hospital inside someone's home.
The objective is to improve function within the environment where the person actually lives.
The CBR Matrix
One of the most important concepts in CBR is the CBR matrix.
It consists of five major components:
Health
promotion
prevention
medical care
rehabilitation
assistive devices
Education
early childhood
primary education
secondary and higher education
non-formal education
lifelong learning
Livelihood
skills development
employment
self-employment
financial services
social protection
Social
personal assistance
relationships
family support
culture and recreation
sports
justice
Empowerment
advocacy
communication
community mobilization
political participation
self-help groups
The matrix demonstrates why CBR should not be reduced to a medical or physiotherapy programme. (World Health Organization)
The Role of Physiotherapy in CBR
Physiotherapy can play a major role within the health component of CBR.
The physiotherapist may be involved in:
assessment
exercise therapy
mobility training
balance training
gait rehabilitation
strengthening
stretching
respiratory rehabilitation
neurological rehabilitation
pain management
prevention of contractures
positioning
pressure injury prevention
assistive-device training
wheelchair skills
caregiver education
home exercise programmes
fall prevention
referral
long-term follow-up
But community physiotherapy also requires something beyond technical treatment skills:
the ability to understand the person's environment.
Physiotherapy in the Community: The Assessment Changes
In a clinic, the physiotherapist might assess:
range of motion
muscle strength
tone
sensation
balance
gait
pain
coordination
endurance
In the community, these remain important.
But the assessment expands.
The physiotherapist may also ask:
About the home
Is there a staircase?
Is the toilet accessible?
What type of flooring is present?
Is there adequate lighting?
Does the patient have a safe place to exercise?
About mobility
Can the person get out of bed independently?
Can they reach the bathroom?
Can they walk outside?
Can they use public transportation?
Can they cross a road safely?
About family
Who provides assistance?
Does the caregiver understand the exercise programme?
Is the caregiver physically capable of helping?
Is caregiver burden becoming a problem?
About participation
Can the person return to school?
Can they return to work?
Can they participate in social activities?
Can they participate in religious or cultural activities?
This is where rehabilitation becomes genuinely person-centred.
A Simple Example: Stroke Rehabilitation at Home
Consider an illustrative patient who has had a stroke.
Clinic goal
Improve:
lower-limb strength
balance
gait speed
Community goal
The patient wants to walk independently from the bedroom to the bathroom and eventually reach the local shop.
The physiotherapist may therefore design training around:
sit-to-stand
turning
obstacle negotiation
walking on uneven surfaces
stair practice
transfers
bathroom safety
appropriate walking aid
endurance
home exercise
caregiver training
The intervention becomes more functional because the therapist is training for the patient's actual environment.
Community Physiotherapy Across Different Conditions
CBR can be relevant to many populations.
Stroke
Physiotherapy may focus on:
gait
balance
transfers
upper-limb function
strengthening
endurance
fall prevention
positioning
caregiver education
community mobility
Spinal Cord Injury
Important areas include:
pressure injury prevention
transfers
wheelchair mobility
strengthening
respiratory function
positioning
contracture prevention
bowel/bladder-related functional education through appropriate multidisciplinary care
community reintegration
accessibility assessment
Cerebral Palsy
Community rehabilitation may include:
mobility
strengthening where appropriate
positioning
contracture prevention
orthotic/assistive-device coordination
participation in school
caregiver education
play and physical activity
communication with education services
Amputation
Community rehabilitation can involve:
residual-limb care
strengthening
balance
prosthetic training
gait
fall prevention
home mobility
community mobility
return to work
participation
Evidence specifically examining community and home-based exercise rehabilitation after lower-limb amputation has highlighted physical function, quality of life, and access/equity as important considerations. (PubMed)
Older Adults
Community physiotherapy can target:
falls
frailty
weakness
balance
gait
endurance
osteoarthritis
functional independence
A systematic review and meta-analysis examining community-based rehabilitation centres in Asian countries found evidence that such programmes can improve several physical-fitness outcomes in community-dwelling older adults, although the exact effects varied across outcomes and studies. (PubMed)
Pediatric Community Rehabilitation
Children require a particularly broad approach.
A physiotherapist may work with:
parents
teachers
caregivers
special educators
occupational therapists
speech therapists
medical professionals
community workers
The goal should not simply be:
"Improve muscle tone."
It may instead be:
"Help the child participate in school activities."
Or:
"Help the child play with other children."
Or:
"Help the child move around the classroom independently."
Recent research examining participation in CBR for children with disabilities emphasizes family-facilitated intervention, referral systems, adequate human resources, and collaboration between professionals, communities, and other stakeholders. (PubMed)
How Does a Community Physiotherapy Visit Work?
A typical visit may follow this sequence.
Step 1: Referral or Identification
The patient may be identified through:
hospital referral
primary healthcare
community health worker
disability organization
school
family
self-referral
Step 2: Initial Assessment
The physiotherapist evaluates:
Body structure and function
strength
ROM
tone
pain
sensation
coordination
endurance
Activity
bed mobility
transfers
standing
walking
stair climbing
reaching
self-care tasks
Participation
school
work
family activities
recreation
social activities
Environmental factors
home accessibility
transportation
assistive devices
caregiver support
community barriers
Personal factors
motivation
goals
beliefs
preferences
socioeconomic circumstances
Step 3: Set Meaningful Goals
Goals should be functional and measurable.
Instead of:
"Improve balance."
A more meaningful goal might be:
"The patient will stand from a chair and walk 20 metres indoors using the prescribed walking aid with supervision."
Or:
"The patient will safely climb five household steps with an appropriate railing and supervision."
Step 4: Design the Intervention
The programme may include:
therapeutic exercise
functional training
gait training
balance exercises
strengthening
stretching
respiratory exercises
education
positioning
assistive-device training
caregiver training
environmental modification
home exercise
Step 5: Train the Family and Caregiver
Caregivers can become important partners in rehabilitation.
They may be taught:
safe transfers
positioning
exercise assistance
walking assistance
fall prevention
pressure injury prevention
safe use of equipment
signs requiring medical referral
However, caregiver involvement should not mean transferring the therapist's entire workload to the family.
The therapist should consider:
caregiver knowledge
physical capacity
time
stress
safety
willingness
Step 6: Referral
A community physiotherapist must recognize when the patient needs additional expertise.
Referral may be required to:
physician
neurologist
orthopedic specialist
rehabilitation physician
occupational therapist
speech therapist
psychologist
social worker
prosthetist/orthotist
specialized rehabilitation centre
CBR is therefore not isolated care.
It should function as a network.
Step 7: Follow-Up
Follow-up may evaluate:
functional independence
exercise adherence
mobility
falls
pain
participation
caregiver concerns
equipment use
new complications
The plan should be modified as the person's needs change.
What Equipment Is Needed?
Community rehabilitation does not always require sophisticated equipment.
Depending on the patient, useful equipment may include:
resistance bands
ankle weights
walking aids
canes
walkers
crutches
wheelchairs
balance aids
exercise mats
steps
chairs
parallel support surfaces
orthoses
prostheses
Technology can also be used when appropriate:
wearable sensors
mobile applications
tele-rehabilitation
video-based exercise programmes
remote monitoring
However, technology should solve a rehabilitation problem rather than simply being added because it is available.
The Importance of Home Exercise
One of the biggest advantages of community physiotherapy is that exercise can be integrated into everyday life.
For example:
Instead of:
"Do 10 sit-to-stands."
The therapist can teach:
"Practice controlled sit-to-stand every time you get up from your chair, provided it is safe."
Instead of:
"Walk for 15 minutes."
The therapist might integrate walking into:
going to the garden
walking inside the house
visiting a nearby shop
attending community activities
The aim is to turn rehabilitation into life participation.
Community Rehabilitation and Assistive Devices
Physiotherapists may help patients use:
canes
walkers
crutches
wheelchairs
orthoses
prosthetic devices
But prescribing or recommending equipment should be based on assessment rather than habit.
A walking aid that is appropriate for one patient may be inappropriate for another.
The therapist should consider:
strength
balance
cognition
upper-limb function
environment
endurance
device height
safety
patient preference
Prevention Is a Major Part of CBR
Community physiotherapy is not only about treating existing disability.
It can also prevent complications.
Examples include:
Stroke
Prevent:
falls
contractures
deconditioning
inactivity-related decline
Spinal cord injury
Prevent:
pressure injuries
contractures
respiratory complications
secondary musculoskeletal problems
Older adults
Prevent:
falls
physical inactivity
loss of strength
functional decline
Children with disabilities
Prevent or manage:
loss of mobility
secondary musculoskeletal problems
inappropriate positioning
reduced participation
Community-Based Rehabilitation and the ICF
The International Classification of Functioning, Disability and Health (ICF) provides a useful way to understand community rehabilitation.
Instead of looking only at disease, the therapist considers:
Body functions and structures
What is impaired?
Activity
What can the person do?
Participation
What can the person participate in?
Environmental factors
What helps or prevents participation?
Personal factors
What individual circumstances influence rehabilitation?
This fits naturally with community physiotherapy.
A Simple ICF Example
Imagine a person after stroke.
Body function
Reduced ankle control.
Activity
Difficulty walking.
Participation
Unable to return to work.
Environmental barrier
Workplace has stairs without a suitable handrail.
Personal factor
Strong desire to return to employment.
A physiotherapist who only treats ankle weakness may miss a major part of the rehabilitation problem.
The community approach asks:
What combination of impairment, activity limitations and environmental barriers is preventing this person from returning to work?
Evidence for Community-Based Rehabilitation
The evidence for CBR is important but needs to be interpreted carefully.
Historically, research has been fragmented. An early systematic literature review found many publications describing CBR but relatively fewer rigorous intervention studies, leading the authors to describe the evidence base as fragmented. (PubMed)
More recent evidence is encouraging but still heterogeneous.
A 2026 systematic literature review identified nine empirical studies and found consistent associations between CBR participation and improvements in areas such as social inclusion, empowerment, participation, and access to services. The authors also noted that stronger evaluation designs are needed and that outcomes should be measured across the different domains of the CBR matrix. (PubMed)
This distinction is important:
CBR may produce meaningful benefits, but not every CBR programme is equally effective.
Programme quality, local resources, community involvement, referral systems, professional support, and evaluation methods can all influence outcomes.
Evidence From India
Community-based rehabilitation has also been studied in India.
A large case-control study from Mandya District, Karnataka, evaluated CBR participation and reported positive effects on well-being and participation within family and community decision-making. The study used propensity-score matching and examined outcomes at different durations after programme entry. (PubMed)
This is particularly relevant because India contains enormous variation in:
geography
healthcare access
socioeconomic conditions
rehabilitation infrastructure
rural and urban populations
disability services
A community model can therefore be highly relevant, but programmes need to be adapted to local conditions rather than copied mechanically from another region.
CBR for Psychosocial Disability
CBR is not limited to physical disability.
A 2024 systematic review of CBR programmes for people with psychosocial disabilities in low- and middle-income countries identified programmes involving health, education, livelihood, social, and empowerment components. The review also identified stigma and lack of resources as important implementation challenges and noted limitations in the quality of programme evaluation. (PubMed)
This reinforces an important principle:
Disability rehabilitation is multidimensional.
Physical recovery alone may not produce social inclusion.
Evidence-Based Practice: What Should a Physiotherapist Do?
A community physiotherapist should combine:
Best available evidence
with
Clinical expertise
and
Patient goals and circumstances.
This means asking:
Does this intervention have evidence?
Is the evidence applicable to this patient?
Is it safe?
Is it affordable?
Can the patient realistically perform it?
Does it address the patient's goals?
Can the family support it?
Can the intervention be sustained after the therapist leaves?
Evidence-based community rehabilitation is therefore not simply about choosing the treatment with the highest research score.
It is about making evidence work in the real world.
Common Challenges in Community-Based Rehabilitation
1. Limited Resources
Some communities have very few rehabilitation professionals or facilities.
2. Transportation
Even when specialized services exist, patients may not be able to reach them.
3. Financial Barriers
Treatment, transportation, equipment, and assistive devices can create significant costs.
4. Caregiver Burden
Family members may already have substantial responsibilities.
5. Cultural Beliefs
Beliefs about disability and rehabilitation may influence participation.
A therapist must communicate respectfully rather than dismissing cultural beliefs.
6. Stigma
Disability-related stigma can reduce:
employment
education
social participation
healthcare access
confidence
7. Poor Referral Networks
A community therapist may identify a problem but have difficulty connecting the patient to appropriate specialized care.
8. Limited Follow-Up
A programme may begin successfully but fail if long-term monitoring is unavailable.
Common Mistakes in Community Physiotherapy
Mistake 1: Recreating the hospital at home
The goal is not to reproduce every piece of equipment.
The goal is meaningful function.
Mistake 2: Ignoring the environment
An excellent exercise programme can fail if the patient cannot safely move around the house.
Mistake 3: Giving too many exercises
A complicated programme may reduce adherence.
Mistake 4: Ignoring caregiver capacity
The family may not have the time or physical ability to provide intensive assistance.
Mistake 5: Focusing only on impairment
A stronger muscle does not automatically mean greater participation.
Mistake 6: Poor documentation
Community care still requires professional documentation.
Mistake 7: No referral plan
The therapist should know when the patient requires another level of care.
How to Make Community Physiotherapy More Effective
A practical approach is:
Assess → Plan → Train → Educate → Adapt → Refer → Follow Up
Assess
Understand the person and environment.
Plan
Set meaningful goals.
Train
Use evidence-based rehabilitation.
Educate
Teach the patient and caregiver.
Adapt
Modify the home and programme where appropriate.
Refer
Connect the patient with other services.
Follow up
Measure whether the intervention is actually improving function and participation.
A Practical Community Physiotherapy Checklist
Before finishing a community visit, consider:
Patient
What are the patient's main goals?
What is the current functional level?
What are the major risks?
What exercises are appropriate?
Home
Is the environment safe?
Are there fall hazards?
Is the bathroom accessible?
Are stairs safe?
Mobility
Is the walking aid appropriate?
Can the patient transfer safely?
Can the patient walk in their real environment?
Family
Does the caregiver understand the plan?
Is the caregiver physically able to assist?
Is caregiver burden present?
Community
Can the patient access school/work?
Can they access healthcare?
Can they participate socially?
Are transportation barriers present?
Follow-Up
What will be measured?
When will reassessment occur?
Is specialist referral required?
Community-Based Rehabilitation Is Not "Cheap Physiotherapy"
This is an important misconception.
CBR should not be viewed as simply a lower-cost version of hospital rehabilitation.
It is a different way of organizing rehabilitation around the person's life and community.
A patient may still require:
advanced imaging
surgery
specialist assessment
intensive neurological rehabilitation
orthotic/prosthetic services
inpatient rehabilitation
specialized equipment
CBR should connect people with those services rather than replacing them.
Community Rehabilitation and Technology
Technology can strengthen community rehabilitation when used appropriately.
Potential tools include:
Tele-rehabilitation
Useful for:
follow-up
education
exercise supervision
consultation
monitoring
Smartphone-based programmes
Can support:
exercise reminders
education
video demonstrations
symptom monitoring
Wearable technology
May help monitor:
steps
activity
gait
heart rate
movement
However, access to technology is not universal.
Therefore:
Technology should support equity, not create another barrier.
The Future of Community Physiotherapy
The future of community rehabilitation is likely to involve greater integration between:
hospitals
primary healthcare
rehabilitation centres
community workers
families
digital health
disability organizations
schools
workplaces
One of the most important developments will be moving from a treatment-centred model toward a participation-centred model.
Instead of asking only:
"How much stronger is the quadriceps?"
we increasingly need to ask:
"Can the person now perform the activities that matter to them?"
Frequently Asked Questions
Is community-based rehabilitation the same as home physiotherapy?
No.
Home physiotherapy is usually a physiotherapy service delivered at home.
CBR is broader and can involve health, education, livelihood, social participation, empowerment, community development, and referral.
Can physiotherapists work independently in CBR?
They can contribute independently within their professional scope, but effective CBR is usually collaborative and multidisciplinary.
Is CBR only for rural areas?
No.
CBR can be relevant in:
rural areas
urban communities
low-resource settings
underserved populations
disability programmes
community health systems
Does CBR replace hospital rehabilitation?
No.
It should complement specialized services and create pathways between community and specialist care.
What is the main goal of CBR?
The ultimate goal is not simply improved muscle strength or range of motion.
It is to support function, independence, participation, inclusion, empowerment, and quality of life.
What is the role of the family?
Families can be important partners in rehabilitation, but they should be supported rather than treated as unpaid substitutes for professional care.
Evidence-Based Takeaway
Community-based rehabilitation represents a major shift in the way rehabilitation can be understood.
It moves rehabilitation:
from clinic → to community
from impairment → to participation
from therapist-centred → to person-centred
from isolated treatment → to coordinated services
from passive patient → to active participant
For physiotherapists, this means technical clinical skills remain essential, but they are not enough.
A community physiotherapist must also understand:
the patient's home
family
culture
occupation
education
transportation
finances
community
accessibility
assistive technology
social participation
The evidence suggests that well-designed CBR programmes can contribute to participation, empowerment, inclusion, and well-being, but the evidence base remains heterogeneous and programme quality matters. Recent research supports continued development of stronger evaluation methods and broader outcome measurement. (PubMed)
Conclusion
A rehabilitation programme does not truly succeed simply because a patient can perform an exercise inside a clinic.
It succeeds when that improvement begins to matter in real life.
When the person can get out of bed.
When they can reach the bathroom safely.
When a child can participate in school.
When an adult can return to work.
When an older person can walk safely to the community centre.
When a wheelchair user can access their neighbourhood.
When a person with disability has a voice in decisions affecting their own life.
That is the deeper purpose of community-based rehabilitation.
Physiotherapy can restore movement—but community-based rehabilitation helps turn movement into participation.
Selected References
World Health Organization, ILO, UNESCO, IDDC. Community-Based Rehabilitation: CBR Guidelines. WHO, 2010. (World Health Organization)
Jacob US, Maguvhe MO. Advancing inclusive development through community-based rehabilitation: a systematic literature review. Frontiers in Rehabilitation Sciences. 2026. PMID: 42553350. (PubMed)
Finkenflügel H, Wolffers I, Huijsman R. The evidence base for community-based rehabilitation: a literature review. International Journal of Rehabilitation Research. 2005;28(3):187–201. PMID: 16046912. (PubMed)
M'kumbuzi VRP, Myezwa H. Conceptualisation of community-based rehabilitation in Southern Africa: A systematic review. South African Journal of Physiotherapy. 2016. PMID: 30135885. (PubMed)
Biggeri M, et al. Do community-based rehabilitation programmes promote the participation of persons with disabilities? A case control study from Mandya District, India. Disability and Rehabilitation. 2014;36(18):1508–1517. PMID: 23944177. (PubMed)
Butura AM, et al. Community-based rehabilitation for people with psychosocial disabilities in low- and middle-income countries: a systematic review of the grey literature. International Journal of Mental Health Systems. 2024;18:13. PMID: 38486243. (PubMed)
Grandisson M, Hébert M, Thibeault R. A systematic review on how to conduct evaluations in community-based rehabilitation. Disability and Rehabilitation. 2014;36(4):265–275. PMID: 23614357. (PubMed)
Effectiveness of Community-Based Rehabilitation Centers for Improving Physical Fitness for Community-Dwelling Older Adults: A Systematic Review and Meta-Analysis. PMID: 38433005. (PubMed)
Effectiveness and Equity in Community-Based Rehabilitation on Pain, Physical Function, and Quality of Life After Unilateral Lower Limb Amputation: A Systematic Review. PMID: 36893877. (PubMed)
A Call for Re-visioning Participation: Realist Review of Participation in Community-based Rehabilitation for the Inclusion of Children with Disabilities in Low-Income and Low-Middle-Income Countries. PMID: 41181293. (PubMed)
