Factors Associated With Mobility Assistive Device Abandonment: A Cross-Sectional Study In Kerala, Southern India

Mobility assistive device (MAD) abandonment may undermine rehabilitation outcomes and represent an inefficient use of scarce resources in low- and middle-income countries, yet factors associated with abandonment within Indian rehabilitation services remain poorly characterised. This study examined service-delivery, sociodemographic, and satisfaction factors associated with MAD abandonment in a southern Indian cohort, using pragmatic, MPT-informed indicator variables in an exploratory cross-sectional framework.

In this cross-sectional study, 150 mobility assistive device users were recruited from five rehabilitation and geriatric-care facilities in Palakkad district, Kerala, using purposive sampling stratified by device type. Device abandonment was defined as complete cessation of use or use below 25% of self-reported prescribed or intended frequency at interview. Bivariate associations were examined using chi-square and Mann-Whitney U tests, with effect sizes reported. Firth-penalised logistic regression was used to examine exploratory cross-sectional associations because of sparse outcome cells.

Of 150 participants, 42 (28.0%; 95% CI 21.4-35.7%) met criteria for device abandonment. Abandonment was higher among participants who reported no device-use instruction and those not involved in device selection. In the primary exploratory model, reported device-use instruction, user involvement in device selection, reported follow-up-service availability, and rural residence were associated with abandonment status; the user-involvement association should be interpreted cautiously because only two abandonment events occurred among involved participants. Lower satisfaction scores were observed concurrently among participants classified as having abandoned their device.

User involvement in device selection, reported device-use instruction, availability of follow-up services, and rural residence were each associated with MAD abandonment in an exploratory, cross-sectionally adjusted model; satisfaction differed substantially between active and abandoned-device users. Given the cross-sectional design, unvalidated pragmatic, MPT-informed indicator variables, and sparse regression cells, these findings are hypothesis-generating and identify candidate service-delivery features for prospective, longitudinal evaluation rather than establishing causal or policy conclusions.