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

To explore perceived benefits, barriers and motivational factors related to exercising with the robotic device ROBERT<b>^®</b> among patients undergoing rehabilitation following spinal cord injury (SC), and to explore physiotherapists’ perspectives on integrating robotic technologies at two inpatient SCI rehabilitation centres. 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. 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. 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. Patients and physiotherapists express optimism about the role of robotic technologies in spinal cord injury rehabilitationPhysiotherapists highlight the need to assess the evidence and cost-effectiveness of new robotic technologies prior to their implementation in clinical practiceDevelopers should continue optimising robotic systems to reduce resource demands and minimise technical failures during training.Successful integration requires the involvement of key stakeholders, including developers, end-users and decision-makers Patients and physiotherapists express optimism about the role of robotic technologies in spinal cord injury rehabilitation Physiotherapists highlight the need to assess the evidence and cost-effectiveness of new robotic technologies prior to their implementation in clinical practice Developers should continue optimising robotic systems to reduce resource demands and minimise technical failures during training. Successful integration requires the involvement of key stakeholders, including developers, end-users and decision-makers