Patients' and physiotherapists' experiences with robotic technologies for lower extremity rehabilitation following spinal cord injury: a reflexive thematic analysis

Purpose: To explore perceived benefits, barriers and motivational factors related to exercising with the robotic device ROBERT® among patients undergoing rehabilitation following spinal cord injury (SC), and to explore physiotherapists’ perspectives on integrating robotic technologies at two inpatient SCI rehabilitation centres.
Methodology: A qualitative study rooted in critical realism was conducted using 12 individual semi-structured interviews with patients with SCI who participated in a pilot randomised controlled trial investigating the potential effectiveness of a robotic-assisted intervention, and three focus group interviews with physiotherapists experienced in the clinical use of robotic technologies.
Results: Thematic analysis identified four themes: the potential of robotic technology (e.g. hope and enhanced training opportunities); limitations of robotic technology (e.g. complexity and technical issues); the unique craft of physiotherapy (e.g. therapeutic relationship and clinical reasoning); and perspectives on successful integration (e.g. organisational and ethical concerns). Both patients and physiotherapists contributed to the first three themes, whereas only physiotherapists contributed to the fourth.
Conclusions: While patients and physiotherapists acknowledged the potential of robotic technologies, their integration into practice was challenged by resource demands and technical limitations. Stakeholders must consider what constitutes sufficient evidence for implementation and collaboratively determine how such technologies should be integrated into SCI rehabilitation.
Trial registration: ClinicalTrials.gov NCT05558254. Registered 28 th September 2022.