LMICs are defined as countries with a cumulative annual gross national income per capita of US$13 205 or less (Table 1) (The World Bank 2022). Many LMICs have a higher prevalence of injuries and long-term conditions requiring rehabilitation services compared to high-income countries (Cieza et al. 2021; Vos et al. 2020). Despite the greater disability burden in LMICs, the quality and quantity of research conducted in these countries are underwhelming. For example, despite being ranked as the number one cause of disability, low back pain lacks primary data from many LMICs (Sharma & McAuley 2022; Tamrakar et al. 2021).

LMICs have different research priorities than high-income countries. Compared to high-income countries, LMICs often have underdeveloped and resource-limited health systems and different disease burdens, with research only starting to catch up. Because of between-country/culture differences in illness beliefs and coping strategies, research from high-income countries (Sharma et al. 2020), where most evidence is generated, may not apply in LMICs. In other words, interventions developed using resources and clinical populations in high-income countries may not be culturally appropriate or feasible in LMICs. For example, education, a commonly recommended intervention for chronic health conditions, needs to consider patients’ socioeconomic and cultural factors (Sharma et al. 2019b). This warrants significant cultural adaptation and testing of healthcare interventions when used in different health settings/systems. Given that there is limited local research on many clinical conditions, clinicians in LMICs are left to rely on research from high-income countries for patient care. Although the need for high-quality research to address local research gaps has been frequently highlighted, research publications from the LMICs remain limited (Buchbinder et al. 2018).

While LMICs may share some common barriers to conducting and publishing research with high-income countries, some challenges are unique to LMIC contexts (Conradie et al. 2018). Many LMICs do not prioritise research, which results in a lack of research funding, no research culture, limited awareness of research and no research workforce (Conradie et al. 2018). LMICs rarely include research funding in their national budgets. Awareness about research is lacking at all levels and therefore health professionals, academic staff and the general public have little to no understanding of research. School and university curricula also lack a research focus.

Academic institutions do not offer adequate research support to their staff and students, who lack research training, ongoing mentorship, research resources and infrastructure (including but not limited to access to online databases), reliable Internet access, secured computers and statistical software. Unfair expectations are imposed on academic staff to generate research productivity without dedicated research hours and administrative support (e.g. research assistants). For example, publishing two or more original research papers is commonly expected in three years for academic promotion. In a survey of researchers from 27 African countries, lack of dedicated research-related roles was the most common barrier identified, reported by 48% of the respondents (Conradie et al. 2018).

Barriers to publishing research are linked with the barriers to conducting research described above. One widely known barrier is language. Writing academic papers can be daunting, especially when writing in a non-native language. Researchers in LMICs who do not speak English as their first language find it especially challenging to write journal articles in English. They also lack local support to improve their writing skills.

The second barrier is related to, as alluded to earlier, the differences in research priorities in LMICs and high-income countries. Many international journals lack geographic diversity in their editorial boards. As a result, the manuscript handling editors (and reviewers) lack adequate understanding of the local research contexts and the need for studies in LMICs when looking from their own lenses of research priorities in high-income countries. Finding reviewers who understand local research contexts is also challenging, further complicating the editorial decision.

Third, researchers in LMICs are frequently the targets of predatory publishers. As a consequence, researchers from LMICs publish their work in ‘predatory’ journals (Shen & Bjork 2015). The researchers see predatory journals as ‘low-hanging fruit’, despite costs associated with publication, because the publishing requirements are easier to meet while the publication process is often swift, in contrast to (international) peer-reviewed reputable journals.

Lastly, some editors/reviewers of international peer-reviewed journals deem research from LMICs to have local relevance and impact only, and therefore flag them as more appropriate for local journals. The major problem with this is that most local journals are not indexed and are therefore often undiscoverable through traditional databases (e.g. PubMed). Publishing in these non-indexed local journals contribute to duplicate research and therefore research waste (Ioannidis et al. 2014; Sharma et al. 2019a). For example, 75% of research on clinical pain in Nepal was published in local journals with duplicate and redundant research (Sharma et al. 2019a). The international research community should facilitate research from LMICs so that this research can make both local and international impacts.

Urgent actions can help address key barriers to conducting and publishing research in LMICs. The potential solutions to each of the barriers are presented in Table 2.

Despite several significant challenges, research with wide-scale implications has started to arise from LMICs which addresses local health research priorities (Guimarães et al. 2021; Liang et al. 2022; Shah et al. 2022; Sharma et al. 2019b). Some prominent journals in physiotherapy, pain, science and medicine have already started to identify the importance of equity, diversity and inclusion in health research which is likely to make a meaningful impact in promoting research from LMICs (McCambridge & Elkins 2021; Palermo et al. 2023; The Editors 2021; The Editors of The Lancet Group 2019; Nature Medicine 2021). Selected publishers also waive publication fees for authors from LMICs to assist in open-access publishing.

Local research in LMICs is necessary to advance science and improve patient care in these settings. However, researchers in LMICs face several unique challenges to conduct and publish their research internationally. The International Society of Physiotherapy Journal Editors and member journals support research from the LMICs to improve the health and lives of the 85% of the world’s population that lives in LMICs.