Fair enough? How developers and clinicians justify who receives physical assistive robotics in rehabilitation.

BACKGROUND: Physical assistive robots are increasingly promoted in rehabilitation. However, it remains unclear how and for whom, physical assistive robots move from laboratory prototypes into rehabilitation practice, and whether this transition mitigates or reproduces existing inequalities in access to rehabilitation. OBJECTIVE: To examine how moral reasoning and institutional arrangements shape who receives physical assistive robots in healthcare and with what consequences for equity in rehabilitation. METHODS: We conducted semi-structured interviews with ten global developers and fifteen clinicians working within the Swedish healthcare system. Using the Economies of Worth framework, we undertook a theory-informed thematic analysis of how participants justify, contest and negotiate decisions about designing, prescribing and funding the development of physical assistive robots. RESULTS: We identified five interconnected patterns: (1) Marketable first, meaningful second; (2) Exclusion and inclusion through institutional rules; (3) Converging and conflicting with the 'universal body'; (4) Participation without power; and (5) Advocacy work under structural constraints. CONCLUSION: Our findings indicate that moral reasoning about physical assistive robots is organised mainly through industrial and market logics, which frequently overshadow civic and care-based values. Consequently, there is a risk of reproducing and amplifying existing inequalities in access to rehabilitation and the use of assistive physical robots. Our study contributes to the debate on health technology and equity by showing how justifications made by developers and clinicians help configure access to emerging technologies in rehabilitation.