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

PURPOSE: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.