Delivery timelines and determinants of assistive technology for mobility and participation in paediatric rehabilitation: a retrospective cohort study

Abstract

Purpose To estimate the proportion and timing of assistive technology (AT) device delivery during paediatric inpatient rehabilitation and identify factors associated with delivery rates. Materials and methods We conducted a retrospective cohort study at a neurorehabilitation centre in Argentina, including patients <22 years with hospital stays >20 days, discharged between January and December 2024, and with at least one mobility- or participation-related AT prescription. The primary outcome was time from prescription to documented delivery during hospitalisation. Delivery probabilities were estimated with Kaplan–Meier curves and compared using the log-rank test. Factors associated with delivery were analysed with multivariate Cox regression, with clustered standard errors by patient. Results Thirty-three patients were included (mean age 10.6 years; 39.4% female). Sixty devices were prescribed; 41 (68.3%) were delivered during the inpatient stay. Median delivery time after prescription was 27 days (IQR 10–64). Cumulative delivery probabilities at 30, 60, and 90 days were 45%, 64.3%, and 72.8%, respectively. In the multivariate model, postural or self-propelled wheelchairs had a lower delivery rate than other devices (adjusted HR 0.32, 95% CI 0.12–0.86; p = 0.02). Devices processed through provincial public health insurance were delivered more slowly compared with social security, private coverage, or out-of-pocket payment (adjusted HR 0.41, 95% CI 0.22–0.76; p < 0.01). No significant associations were observed for prescription timing or clinical priority classification. Conclusion Nearly one-third of prescribed AT devices for mobility and participation were not delivered before discharge, and delivery times were often prolonged, particularly for wheelchairs and devices processed through provincial public insurance.