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Table 2 Study characteristics of reviewed studies

From: Patient, carer, and staff perceptions of robotics in motor rehabilitation: a systematic review and qualitative meta-synthesis

Study Aim(s) Design Sample Condition and target area of rehabilitation Method of data collection and analysis
Ates et al., 2014 [58]; Three EU countries (unspecified) To report on the technical challenges presented by the use of SPO and the feedback from therapists and patients Technical & performance evaluation 24 patients; 33–81 years; 11 m and 9 f
No information about the therapists
Stroke; hand impairment Clinical observation and descriptive summary into themes
Beveridge et al., 2015 [34]; Canada To explore the experiences and perspectives of parents whose young, ambulatory children with CP were undergoing Lokomat gait training, and consider how parents' values about walking influenced therapy decisions for their children Qualitative descriptive design 5 mothers and 1 fathers of 5 (4 m and 1 f) children; children aged 5–11 years; 2 parents were Anglo-Canadian and the others from Asian backgrounds Cerebral palsy; walking rehabilitation Individual, semi-structured, face-to-face interviews; followed the Dierckx de Casterle approach to analysis of qualitative data: the Qualitative Analysis Guide of Leuven (QUAGOL)
Bezmez and Yardimci, 2016 [54]; Turkey To explore the role of a robotic gait training device (Lokomat) and its role in rehabilitation in Turkey Ethnographic study 42 participants; 7 doctors, 2 nurses, 2 physiotherapists, 2 non-medical personnel, 20 in-patients, and 9 former patients Traumatic injury or illnesses; bodily disability and inability to walk Individual, semi-structured interviews; no information provided on the method of analysis
Cahill et al., 2018 [25]; Ireland To gain an understanding of the experience of using a RWD within a gym-based setting from the perspective of non-ambulatory individuals with SCI Qualitative methodology 4 males and 1 female; mean age 40.75 Spinal cord injury; walking rehabilitation In-depth semi-structured interviews; thematic analysis
Danzl et al., 2013 [41]; USA To investigate the feasibility of combining tDCS to the LE motor cortex with novel locomotor training to facilitate gait in subjects with chronic stroke and low ambulatory status; and to obtain insight from participants and their carers to inform future trial design Mixed methods: a double-blind, sham-controlled, randomized quantitative design and an exploratory descriptive qualitative design Final sample 8 patients; 4 males and 4 females; mean age of 67.8 years (range, 44–80 years) Stroke; lower limb (gait) rehabilitation Semi-structured interviews; inductive thematic analysis
Eicher et al., 2019 [27]; Germany To identify differences regarding usability, acceptability, and barriers of usage of a robot-supported gait rehabilitation system between a younger and older group of patients with gait impairments Pilot/feasibility study assessing system usability of a robot-supported gait rehabilitation system between a younger and older group of patients with gait impairments 13 completed all sessions; 7 were older patients (group G: 75 mean age, range 69–84), 6 were younger patients (group Y: 36 mean age, range 20–55); 11 male and 2 females Stroke/brain haemorrhage, hemiplegia, other (e.g., accidents, falls, not specified); gait rehabilitation Structured interviews; qualitative content analysis by Mayring (2010)
Elnady et al., 2018 [35]; Canada To describe users’ perceptions about existing wearable robotic devices for the upper extremity; identify if there is a need to develop new devices for the upper extremity and the desired features; and to explore obstacles that would influence the utilization of these new devices Exploratory focus group discussions Group 1: 8 people with stroke (1 f and 7 m);
Group 2: 8 therapists: 4 Physiotherapists, 2 Occupational therapists; 2 Rehabilitation assistants (8 f)
Stroke; upper limb rehabilitation Focus groups; thematic analysis
Flynn et al., 2019 [53]; Australia To explore occupational therapists’ and physiotherapists’ perceptions of robotic therapy for the upper limb and the perceived barriers and enablers influencing implementation Qualitative methodology involving two discipline-specific focus groups 12 participants: 6 occupational therapists (mean age = 29 years, range = 24–39) and 6 physiotherapists (mean age = 30, range = 23–51); 9 female and 3 males Stroke; upper limb movement at the shoulder, elbow and hand (with the wrist fixed in neutral or pronation) Focus groups; data were deductively analysed using the Theoretical Domains Framework (TDF)
Gilbert et al., 2018 [46]; UK To determine whether or not the MUJO System was acceptable to patients with shoulder dysfunction and their rehabilitation professionals Qualitative study 10 patients (median age was 38.5 years, range = 19–54; 5 f and 5 m) and 7 physiotherapists Shoulder instability (n = 6) and rotator cuff related pain (n = 4); rehabilitation of the rotator cuff muscles (bi-articular muscles or multiple axial joints) Interviews; Directed Content Analysis was undertaken to organise the qualitative data according to the four constructs of Normalisation Process Theory (NPT)
Heinemann et al., 2018 [28]; USA To describe clinicians’ experiences, evaluations, and training strategies using exoskeletons in rehabilitation and wellness settings Qualitative focus groups 30 healthcare professionals: 90% Physical therapist, 2% Administrative, 8% Other clinical role (exercise therapist, recreational therapist); mean age was 37, range = 28–53; 86% female Spinal cord injuries; Standing and gait rehabilitation Focus groups; thematic analysis
Heinemann et al., 2020 [42]; USA To describe appraisals of robotic exoskeletons for locomotion by potential users with spinal cord injuries, their perceptions of device benefits and limitations, and recommendations for manufacturers and therapists regarding device use Qualitative focus groups 35 patients; mean age = 48; 17% female Spinal cord injuries; Gait rehabilitation Focus groups; thematic analysis
Hochstenbach-Waelen and Seelen, 2012 [55]; The Netherlands To identify criteria and conditions that people, involved in development of rehabilitation technology for upper limb training of stroke patients, should take into account to achieve a (more) successful implementation of the technology in daily clinical practice Literature search and interviews 6 senior physiotherapists and occupational therapists Stroke; upper limb rehabilitation Semi-structured interviews; method of data analysis was not reported
Hughes et al., 2011 [47]; UK To understand the stroke participants’ experiences of using the novel combination of a robotic arm and iterative learning control system and to gain greater insight into how systems might be improved in the future Mixed-methods study, involving open-ended and closed questions 5 patients; mean age was 52 years (range = 38–77); 3 males and 2 females Stroke; upper limb rehabilitation Two ways data were collected: comments were recorded during the time when participants were receiving the intervention and immediately following the clinical study, an interview based question set was used; content analysis
Huq et al., 2012 [36]; Canada To develop a portable robotic system with a haptic interface that facilitates the concept of rehabilitation at a remote location, e.g., at a home; to develop a GUI that integrates different control techniques and VR games in the same screen, and allows therapists to easily interact with the system; and to evaluate the current system with therapists in a focus group study Focus group study 3 physiotherapists and 4 occupational therapists Stroke; upper limb rehabilitation Focus groups; summary of findings
Kumar and Phillips, 2013 [48]; UK To explore the views, experiences, benefits, and difficulties that users of one specific type of PMAS perceive, and determine which areas of daily life they are used in Mixed-methods approach, including questionnaire and interviews 13 patients; age range = 13–69 years (12 men and boys, mean age 25 years, mode age 14 years; and 1 woman, 69 years) Neuromuscular conditions; upper limb rehabilitation Semi-structured interviews; thematic analysis
Lajeunesse et al., 2018 [37]; Canada To present the perspectives of individuals with ASIA C or D incomplete SCI concerning the usability of lower limb exoskeletons to R&D engineers and clinicians working in motor rehabilitation Exploratory qualitative research design with a user-centred approach 13 patients; 6 males (mean age = 59.8) and 7 females (mean age = 43) Incomplete spinal cord injury; lower limb rehabilitation Individual, semi-structured interviews; inductive thematic analysis
Lo et al., 2020 [56]; Asia, Australia, Europe and USA To inform rehabilitation clinicians about the various aspects of adopting and integrating robotic stroke therapy into clinical settings Qualitative description design 8 rehabilitation therapists Stroke and other neurological conditions, such as spinal cord injury, multiple sclerosis (MS), brain tumours and traumatic brain injuries; upper and lower limb training Semi-structured interviews; qualitative descriptive analysis
Manns et al., 2019 [26]; Canada To explore the expectations and experiences of persons with spinal cord injury, training with the ReWalk exoskeleton Qualitative research design 11 patients (mean age = 37.5, range = 18–65 years); 4 females and 7 males Traumatic spinal cord injury; standing and walking training Semi-structured interviews; thematic analysis
Mortenson et al., 2020 [38]; Canada To explore the experiences of physiotherapists with the introduction of an exoskeleton as a gait retraining device in a Canadian rehabilitation centre Longitudinal qualitative study 10 therapists (one group of therapists, n = 4, was formally trained using the device, whereas the other group only had clinical exposure to the device, n = 6); mean age = 40 years; 8 females and 2 males Brain and spinal cord injuries; gait training Semi-structured interviews; thematic analysis
Nasr et al., 2015 [57]; UK, Italy and the Netherlands To examine stroke survivors’ experiences of living with stroke and with technology in order to provide technology developers with insight into values, thoughts and feelings of the potential users of a to-be-designed robotic technology for home-based rehabilitation of the hand and wrist Interdisciplinary research design and qualitative study 10 households (10 patients and 8 carers); age range = 60–77; 7 males and 3 females Stroke; upper limb rehabilitation Application of qualitative methods such as in-depth interviews as well as using diaries and photography activities; thematic analysis
O' Brien Cherry et al., 2017 [43]; USA To determine participants’ general impressions about the benefits and barriers of using RT devices for in-home rehabilitation Qualitative study design employing ethnographic- based anthropological methods 10 veterans (plus their carers); age range = 49–88; all males Stroke; upper or lower limb impairments Direct observations and semi-structured interviews; inductive thematic analysis
Phelan et al., 2015 [39]; Canada To investigate the expectations and experiences of children with CP in relation to robotic gait training using the Lokomat Pro An interpretivist qualitative design 5 children (8–11 years; 3 boys and 2 girls) and their parents (28–52 years; 3 mothers and 2 fathers); Cerebral palsy; gait rehabilitation Observations during sessions, semi-structured interviews with parents and use of a customizable “toolbox” of age-appropriate child-friendly techniques; thematic analysis
Read et al., 2020 [40]; Canada To explore how the training and implementation of using the Ekso robotic exoskeleton with patients affects physiotherapists’ work An exploratory qualitative research design 3 physiotherapists Individuals with SCIs and hemiplegia due to stroke; gait training One-on-one semi-structured interviews; thematic analysis
Sivan et al., 2016 [49]; UK To evaluate the ICF as a framework to ensure that key aspects of user feedback are identified in the design and testing stages of development of a home-based upper limb rehabilitation system Qualitative study 17 patients and 7 physiotherapists and occupational therapists Stroke; upper limb rehabilitation Face-to-face semi-structured interviews; analysis based on the updated International Classification of Functioning, Disability and Health (ICF) linking rules and core set categories
Stephenson and Stephens, 2018 [50]; UK To explore physiotherapists' experience of using RT in rehabilitation of the upper limb, within a stroke rehabilitation centre Phenomenological approach/qualitative study 6 physiotherapists; 3 males and 3 females Stroke; upper limb rehabilitation Semi-structured interviews; thematic analysis
Swank et al., 2020 [44]; USA To describe therapists’ clinical practice experiences with robotic gait training (RGT) over 3 years during inpatient rehabilitation Mixed methods study, including a survey and semi-structured focus group 10 physical therapists Condition not specified; gait training Semi-structured focus group; thematic analysis
Swank et al., 2020b [29]; USA To determine the feasibility of integrating the Ekso Gait Training device into inpatient rehabilitation in a neurologic population Longitudinal cohort design, including a focus group (therapists) and survey (therapists and patients) Physical therapists (exact number not reported) Stroke and SCI; gait training Semi-structured focus group; thematic analysis
Sweeney et al., 2020 [51]; UK To understand user perceptions in order to explain low uptake of upper limb rehabilitation interventions after stroke in clinical practice within the National Health Service (NHS Scotland) Qualitative study using a mixed-methods approach, consisting of a cross-sectional online survey with therapists and semi-structured interviews with stroke patients 8 stroke patients from a Constraint Induced Movement Therapy (n = 2) and Robotic Therapy (n = 6) groups Stroke; upper limb rehabilitation Semi-structured interviews; thematic analysis
Tedesco Triccas et al., 2018 [52]; UK To explore views and experiences of people with sub-acute and chronic stroke that had previously taken part in a randomised controlled trial involving tDCS and RT for their impaired upper limb A structured and semi-structured interview study, involving qualitative and quantitative components 21 patients; 12 males and 9 females; mean age was 64.2 Stroke; upper limb rehabilitation Interviews involving open questions; thematic analysis
Thomassen et al., 2019 [45]; USA To generate new knowledge regarding user experiences of standing and walking with Ekso™ (Ekso Bionics, Richmond, CA, USA) Qualitative (interview) study 3 patients; all male of different ages (from young adult to middle aged) Spinal cord injury (due to traumatic and non-traumatic reasons); standing and walking training In-depth interviews in a phenomenological tradition; systematic inductive content analyses
  1. ASIA American Spinal Injury Association, CP cerebral palsy, f female(s), GUI graphical user interface, ICF International Classification of Functioning, Disability and Health, LE lower extremity, m male(s), PMAS powered mobile arm support, R&D research and development, RT robotic therapy, RWD robotic walking device, SCI spinal cord injury, SPO SCRIPT Passive Orthosis, tDCS transcranial direct current stimulation, VR virtual reality