DEVELOPMENT AND EVALUATION OF A NURSE-LED SELF-DIRECTED PEDIATRIC REHABILITATION MODEL: COMPARATIVE ANALYSIS OF INTERNATIONAL PRACTICES.

BACKGROUND: Pediatric rehabilitation has become a global health priority due to increasing survival among children with neurodevelopmental disorders and medical complexity. Although nurse-led rehabilitation models are increasingly recognized as effective approaches for improving continuity of care and rehabilitation outcomes, considerable international variation persists in nursing roles, organizational structures, and integration of digital health strategies, particularly in transitional health systems. AIM: To systematically map and compare international nurse-led pediatric rehabilitation models, focusing on organizational structures, scope of nursing practice, care coordination mechanisms, rehabilitation outcomes, and digital health integration, in order to develop an evidence-informed conceptual framework for a nurse-led self-directed pediatric rehabilitation model adaptable to transitional health systems. METHODS: A scoping review was conducted in accordance with the PRISMA-ScR guidelines using the Arksey and O'Malley methodological framework with refinements proposed by Levac et al. electronic searches were performed in PubMed/MEDLINE, Scopus, Web of Science, CINAHL, Embase, and relevant grey literature sources for studies published between January 2015 and March 2026. Eligible studies included empirical investigations of nurse-led, advanced practice nursing, or nurse practitioner-led pediatric rehabilitation models across hospital, outpatient, community, and home-based settings. Data were synthesized using a thematic narrative approach. RESULTS: The search identified 6,842 records, of which 56 studies met the eligibility criteria. Four principal nurse-led pediatric rehabilitation models were identified: nurse practitioner-led clinical care, advanced practice nursing coordination, integrated multidisciplinary nursing models, and physician-led rehabilitation with nursing support. Comparative analysis demonstrated substantially greater nursing autonomy, broader clinical responsibilities, and more mature rehabilitation systems in high-income countries than in transitional health systems. Five core domains of nursing practice were consistently identified: functional assessment, care coordination, rehabilitation intervention support, family-centered education, and multidisciplinary integration. Digital health strategies-including teleconsultation, telerehabilitation, remote monitoring, and self-directed rehabilitation interventions-were consistently associated with improved adherence, continuity of care, caregiver engagement, and health system efficiency. A multidimensional structural gap was identified in transitional health systems, including Kazakhstan, characterized by limited nursing autonomy, fragmented rehabilitation pathways, and insufficient organizational support for advanced nursing practice. CONCLUSION: International evidence supports nurse-led pediatric rehabilitation as an effective approach for improving rehabilitation coordination, continuity of care, caregiver engagement, and health system performance. The proposed evidence-informed conceptual framework integrates advanced nursing practice, multidisciplinary collaboration, family-centered care, and digital rehabilitation strategies into a scalable model that may facilitate implementation of nurse-led self-directed pediatric rehabilitation in Kazakhstan and other transitional health systems undergoing rehabilitation and nursing workforce transformation.

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