Stroke burden and rehabilitation need in Eastern Europe
https://doi.org/10.17749/2949-5873/rehabil.2025.59
Abstract
Background. Despite declining stroke mortality in Eastern European countries, the burden of stroke measured as years lived with disability (YLD) has not shown a decreasing trend, giving rise to the so-called “rehabilitation paradox”.
Objective: To assess trends in the burden of stroke in Lithuania, Russia, Moldova, Estonia, and Czechia from 2010 to 2021, and to model neurorehabilitation needs and workforce shortages.
Material and methods. A secondary analysis of data from the Global Burden of Disease Study (GBD) 2021 was conducted. Both absolute YLD counts and YLD rates per 100,000 population were examined. The estimated annual percentage change (EAPC) for 2010–2021 was calculated. Based on GBD data, the demand for neurorehabilitation services was modeled and workforce shortages were estimated for the countries under analysis.
Results. In 2021, the highest YLD rates per 100,000 population were observed in Lithuania (333.3) and Russia (305.8). A decline in YLD was identified in Estonia (EAPC –0.9%; –9.7% from 2010 to 2021) and Czechia (EAPC –1.6%; –14.6% from 2010 to 2021). In Russia, the absolute YLD burden increased by 2.2% (up to 454.3 thousand individuals). The shortage of rehabilitation professionals was estimated at 14,855 in Russia, 366 in Moldova, and 282 in Lithuania. Sensitivity analysis for 2010–2019 confirmed the observed trends; the impact of COVID-19 was found to be moderate.
Conclusion. A rehabilitation gap persists across all five countries. Scaling up neurorehabilitation services in accordance with the standards of the European Stroke Organisation and the World Health Organization is required.
About the Authors
E. S. Akarachkova
International Society “Stress under Control” ; Rehaline Rehabilitation Center
Russian Federation
Russian Federation
Elena S. Akarachkova, Dr. Sci. Med.
40 Musa Dzhalil Str., Moscow 115573
8 Lesnaya Str., Moscow Region, Istra District, Pavlovskaya Sloboda 143581
O. V. Kotova
International Society “Stress under Control” ; Peoples' Friendship University of Russia named after Patrice Lumumba ; Moscow Regional Research and Clinical Institute
Russian Federation
Russian Federation
Olga V. Kotova, PhD, Assoc. Prof.
40 Musa Dzhalil Str., Moscow 115573
6 Miklukho-Maklay Str., Moscow 117198
61/2 Shchepkin Str., Moscow 129110
D. I. Lebedeva
Tyumen State Medical University ; Regional Treatment and Rehabilitation Center
Russian Federation
Russian Federation
Dzhinna I. Lebedeva, Dr. Sci. Med., Prof.
54 Odesskaya Str., Tyumen 625023
11/2 Shchors Str., Tyumen 625048
References
1. GBD 2021 Stroke Collaborators. Global, regional, and national burden of stroke and its risk factors, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021. Lancet Neurol. 2024; 23 (10): 973–1003. https://doi.org/10.1016/S1474-4422(24)00369-7.
2. GBD 2019 Stroke Collaborators. Global, regional, and national burden of stroke and its risk factors, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet Neurol. 2021; 20 (10): 795–820. https://doi.org/10.1016/S1474-4422(21)00252-0.
3. Langhorne P., Bernhardt J., Kwakkel G. Stroke rehabilitation. Lancet. 2011; 377 (9778): 1693–702. https://doi.org/10.1016/S0140-6736(11)60325-5.
4. Xu J., Hou S., Chen Z., et al. The burden of ischemic stroke in Eastern Europe from 1990 to 2021. BMC Neurol. 2025; 25 (1): 74. https://doi.org/10.1186/s12883-025-04081-z.
5. OECD. The state of cardiovascular health in the European Union. Paris: OECD Publishing; 2025. Available at: https://doi.org/10.1787/ea7a15f4-en (accessed 14.03.2026).
6. World Health Organization. Rehabilitation 2030: a call for action: 6–7 February 2017, Executive Boardroom, WHO Headquarters, meeting report. Available at: https://iris.who.int/handle/10665/339910 (accessed 14.03.2026).
7. Mikulík R., Caso V., Bornstein N.M., et al. Enhancing and accelerating stroke treatment in Eastern European region: methods and achievement of the ESO EAST program. Eur Stroke J. 2020; 5 (2): 204–12. https://doi.org/10.1177/2396987319897156.
8. von Elm E., Altman D.G., Egger M., et al. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Lancet. 2007; 370 (9596): 1453–7. https://doi.org/10.1016/S0140-6736(07)61602-X.
9. Cieza A., Causey K., Kamenov K., et al. Global estimates of the need for rehabilitation based on the Global Burden of Disease study 2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet. 2021; 396 (10267): 2006–17. https://doi.org/10.1016/S0140-6736(20)32340-0.
10. Norrving B., Barrick J., Davalos A., et al. Action Plan for Stroke in Europe 2018--2030. Eur Stroke J. 2018; 3 (4): 309–36. https://doi.org/10.1177/2396987318804177.
11. Gimigliano F., Negrini S. The World Health Organization “Rehabilitation 2030: a call for action”. Eur J Phys Rehabil Med. 2017; 53 (2): 155–68. https://doi.org/10.23736/S1973-9087.17.04746-3.
12. National Institute for Health and Care Excellence. Stroke rehabilitation in adults. NICE guideline NG236. London: NICE; 2023. Available at: https://www.nice.org.uk/guidance/ng236 (accessed 14.03.2026).
13. Shurupova M.A., Aizenshtein A.D., Ivanova G.E. Cost-effectiveness analysis of early medical rehabilitation of patients with cerebral stroke. Bulletin of Rehabilitation Medicine. 2022; 21 (1): 24–33 (in Russ.). https://doi.org/10.38025/2078-1962-2022-21-1-24-33.
14. Béjot Y., Bailly H., Durier J., Giroud M. Epidemiology of stroke in Europe and trends for the 21st century. Presse Med. 2016; 45 (12 Pt 2): e391–8. https://doi.org/10.1016/j.lpm.2016.10.003.
15. Feigin V.L., Norrving B., Mensah G.A. Global burden of stroke. Circ Res. 2017; 120 (3): 439–48. https://doi.org/10.1161/CIRCRESAHA.116.308413.
Review
For citations:
Akarachkova E.S., Kotova O.V., Lebedeva D.I. Stroke burden and rehabilitation need in Eastern Europe. Journal of Medical Rehabilitation. 2025;3(4):223-230. (In Russ.) https://doi.org/10.17749/2949-5873/rehabil.2025.59
Views:
41
JATS XML
Email this article 