Nonuse and Nonpurchase of Assistive Devices After Stroke: An Exploratory Interview Study of Retrospective Device Histories Among Community-Dwelling Adults.

Abstract

Background/objectives: Because function typically improves after stroke, the devices people need, and for how long, may change along the recovery trajectory. This exploratory study examined retrospective accounts of assistive device use, discontinuation, replacement, and nonpurchase across two post-onset stages, hospitalization and home and community reintegration.

Methods: Ten community-dwelling adults with chronic stroke (mean disability duration 13.9 years) were interviewed twice at home, with caregivers contributing where present, and reconstructed their device histories from recall; the resulting accounts are treated as joint participant-caregiver reports. Instruments followed the Human-Activity-Assistive Technology (HAAT) model; field notes and completed device checklists were analyzed by inductive qualitative content analysis, and facilitators and barriers were classified with the World Health Organization people-centered assistive technology (5P) framework. Aggregate figures for the stroke subsample of the 2020 National Survey on Persons with Disabilities (n = 662) are reported as national context rather than as independent confirmation.

Results: Participants reported having used a mean of 11.2 device types, yet named only 1.3 devices that were needed but not purchased. Discontinuation was concentrated among devices used during inpatient rehabilitation: standing frames (9/9), walkers (5/5), and manual wheelchairs (8/10) had been set aside. Functional improvement was the only reason recorded for walkers, but for standing frames and manual wheelchairs it was recorded alongside cost, bulk, replacement, and, in one case, continuing unmet need, so its independent contribution could not be established. A second cluster reflected the poor fit of body-worn devices to a changing hemiplegic limb (ankle-foot orthoses, 4/6). The nonpurchase barrier reported most often was inability to find a suitable product on the market.

Conclusions: These retrospective accounts from ten participants cannot support policy conclusions. They generate hypotheses, requiring prospective testing, about whether ownership-based funding with fixed durability periods fits stage-limited need and whether rental provision, prescription-based provision for orthoses, and targeted product development would fit it better.