Understanding the Drivers and Cost Impact of Traditional Medicine Use for Stroke Rehabilitation in India: Insights from the ATTEND Trial

Introduction: Traditional medicines are used to meet a variety of health needs by people across India, but few data exist for their use by those affected by stroke. We aimed to assess the prevalence, costs, and drivers of traditional medicines used by patients with stroke and in relation to defined sociodemographic characteristics. Methods: This study presents a post hoc analysis of the Family-led Rehabilitation after Stroke in India (ATTEND), a multicentre, prospective, randomised, open blinded endpoint (PROBE) trial conducted at 14 hospitals in India. Data were obtained on the use of non-modern medical treatments and associated financial implications. Multivariable logistic regression was used to identify the predictors of traditional medicine use and reported as adjusted odds ratio (aOR) and 95% confidence intervals (CIs). Financial impacts and their 95% uncertainty intervals were estimated for all new stroke cases in 2022 (80 INR = 1 USD). Results: Of 1, 250 randomised participants, 968 had sufficient data for analysis (age 57.7 [±13.6] years). The overall prevalence of traditional medicine use was 21.1%. Lower use of traditional medicine was associated with high school/college education (aOR: 0.55, 95% CI: 0.30, 0.98) and mild neurological severity (National Institutes of Health Stroke Scale [NIHSS] score <5; aOR: 0.32; 95% CI: 0.14, 0.72). There was no significant association with age (aOR: 1.76; 95% CI: 0.85, 3.64), unemployment (aOR: 2.16, 95% CI: 0.99, 4.74), pre-stroke dependency (aOR: 1.96, 95% CI: 0.46, 8.36), and living accommodation (aOR: 1.13, 95% CI: 0.53, 2.41). We calculated that traditional medicine costs USD 67 million annually: a higher cost burden among men (USD 36 million) compared to women (USD 31 million; 80 INR = 1 USD). Conclusions: Our study indicates that 1 in five patients used traditional medicine following acute stroke in India, with significant financial bearings on individuals and their families. There is greater use in those with more severe strokes and with lower education. More evidence is required on the efficacy of traditional medicines and their role in the healthcare system.