Healthcare professionals’ awareness,perceptions,and adoption of robotic-assisted rehabilitation technologies for stroke recovery

Introduction

Stroke is a major public health concern and a leading cause of long-term disability worldwide. Its impact on patients’ physical, psychological, and social well-being underscores the need for effective rehabilitation strategies to enhance quality of life and reduce the burden on healthcare systems. ¹

Robotic-assisted rehabilitation technologies (RAT) have gained attention for their potential to improve motor recovery and independence in stroke survivors by enabling repetitive, task-specific training, providing precise feedback, and reducing the physical demands on healthcare professionals, thereby promoting neuroplasticity.^2–4 In this study, RAT refers collectively to both upper-limb systems, which target arm and hand function, and lower-limb systems, commonly called robotic-assisted gait training, which focus on mobility; both share principles of high-intensity, task-specific repetition with real-time feedback. ⁵ RAT has shown meaningful improvements in functional outcomes for both upper- and lower-limb stroke recovery, offering intensive, task-specific, and feedback-driven training that supports neuroplasticity. Recent evidence also highlights the importance of personalized rehabilitation approaches that account for individual differences among stroke survivors, emphasizing the role of motivation, engagement, and patient-centered therapy in optimizing recovery.^6–8 Technologies such as robotic systems can enhance patient involvement and provide tailored interventions, supporting healthcare professionals -particularly physiotherapists-in delivering more precise, consistent, and effective treatment aligned with each patient’s needs.

Healthcare professionals’ awareness, perceptions, and adoption of emerging rehabilitation technologies have been widely examined across diverse healthcare systems. International studies consistently show that clinicians’ acceptance of robotic and digital rehabilitation technologies is influenced by factors such as perceived effectiveness, safety, usability, cost, institutional backing, and training access.^9–11 While many clinicians acknowledge the potential of robotic-assisted rehabilitation to enhance motor recovery and therapy efficiency, real-world adoption remains variable and often limited, even in well-resourced healthcare settings.^12,13 These findings highlight a persistent gap between technological advancement and clinical implementation, underscoring the need to better understand contextual and professional determinants of adoption.

Most existing evidence on robotic-assisted rehabilitation originates from high-income Western countries, with limited data from Middle Eastern healthcare systems. In Saudi Arabia, where stroke prevalence is estimated at 29.8 per 100,000 individuals and rehabilitation services remain largely reliant on conventional physiotherapy, empirical research on healthcare professionals’ awareness, perceptions, and adoption of robotic-assisted rehabilitation technologies is scarce.^14–16 Previous studies have identified barriers to RAT adoption, including high costs, limited availability, insufficient training, and low awareness among healthcare providers. ¹⁷ Overcoming these barriers is essential to modernize stroke rehabilitation and supports the objectives of Saudi Vision 2030, which emphasizes healthcare innovation, technological advancement, and improved patient outcomes. ¹⁸

To address these gaps, this study investigates healthcare professionals’ awareness, perceptions, and adoption of RAT for stroke rehabilitation in Jeddah, Saudi Arabia. Specifically, it assesses participants’ level of awareness, explores perceptions regarding the effectiveness, safety, and perceived cost of these technologies, and identifies barriers and facilitators that may influence their integration into clinical practice. The ultimate goal is to provide insights that can guide strategies to enhance RAT adoption and support improved rehabilitation outcomes for stroke patients.

Methods

Results

Demographic characteristics of participants

A total of 210 healthcare professionals participated in the study. Table 1 presents the demographic distribution. The majority were female (56.2%), and the predominant age group was 31–45 years (36.2%), followed by 20–30 years (35.2%). Most participants held a bachelor’s degree (54.8%), and 38.2% had 6–10 years of experience. Regarding professions, physical therapists constituted the largest group (47.6%), followed by occupational therapists (23.8%) and neurologists (19%).

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Table 1.

Demographic characteristics of healthcare professionals in the studied sample (n = 210).

Demographic data of healthcare professionals		N (%)
Gender	Female	118 (56.2%)
	Male	92 (43.8%)
Age	20-30 years	74 (35.2%)
	31-45 years	76 (36.2%)
	46+ years	60 (28.6%)
Education Level	Diploma	20 (9.5%)
	Bachelor’s degree	115 (54.8%)
	Master’s degree	53 (25.2%)
	Doctorate or higher	22 (10.5%)
Years of Experience	0–5 years	49 (23.3%)
	6–10 years	80 (38.2%)
	11–15 years	53 (25.2%)
	16+ years	28 (13.3%)
Healthcare Profession	Neurologist	40 (19%)
	Physical therapist	100 (47.6%)
	Occupational therapist	50 (23.8%)
	Other	20 (9.5%)

Awareness and perceptions of robotic-assisted therapy

Table 2 summarizes awareness and perception levels. Overall, 59.7% of respondents had heard of robotic-assisted therapy for stroke rehabilitation, while 50% reported a moderate level of understanding. Regarding perceived effectiveness, 54.5% believed RAT is effective, 23.7% considered it moderately effective, and 21.8% perceived it as ineffective. In terms of safety, 54% considered RAT safe, 25% moderately safe, and 21% unsafe.

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Table 2.

Awareness and perceptions of robotic-assisted technologies among healthcare professionals (n = 210).

Domain	Questions		N (%)	Min	Max	Mean ± SD
Awareness	Have you heard of robotic-assisted therapy for stroke rehabilitation?	Yes	125 (59.7%)	0	1	0.60 ± 0.49
		No	85 (40.3%)
	How would you rate your level of understanding of robotic-assisted therapy?	High	16 (7.4%)	1	3	1.96 ± 0.76
		Moderate	105 (50%)
		Low	89 (42.3%)
Perception	What is your perception of the effectiveness of robotic-assisted therapy in improving stroke recovery?	Effective	114 (54.5%)	1	3	2.40 ± 0.78
		Moderately effective	50 (23.7%)
		Ineffective	46 (21.8%)
	Based on your experience, how safe do you perceive robotic-assisted therapy to be?	Safe	113 (54%)	1	3	2.29 ± 0.82
		Moderately safe	53 (25%)
		Unsafe	44 (21%)

The overall mean awareness score was 1.25 ± 0.49, indicating moderate awareness, while the mean perception score was 2.41 ± 0.57, reflecting generally positive perceptions toward RAT. Awareness scores were significantly associated with age, educational level, and years of experience (all p < 0.05). Similarly, perception scores, including views on effectiveness and safety, were significantly associated with profession, gender, and years of experience (all p < 0.05), with more experienced professionals and those in specific disciplines demonstrating higher perception scores.

Clinical adoption of robotic-assisted therapy

Only 30.4% (n = 64) of respondents reported incorporating RAT into their clinical practice (Table 3). Among these users, exoskeleton devices were most frequently utilized (53.1%), followed by end-effectors (35.9%). In terms of usage frequency, 59.4% reported rare use, 23.4% used RAT monthly, and 17.2% used it weekly; no participants reported daily use.

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Table 3.

Clinical practice and adoption of robotic-assisted technologies among RAT users (n = 64).

Variables	N (%)
Use of robot-assisted therapy for stroke rehabilitation	64 (30.4%)
Type of robotic device used
Exoskeleton	34 (53.1%)
End-effector	23 (35.9%)
Other	7 (11%)
Frequency of robotic-assisted therapy usage
Daily	0 (0%)
Weekly	11 (17.2%)
Monthly	15 (23.4%)
Rarely	38 (59.4%)

Clinical adoption (actual use of RAT) was significantly associated with age (p < 0.01), profession (p < 0.05), and years of experience (p < 0.001), with older and more experienced professionals showing greater adoption. Major barriers to adoption included high cost (32.4%), limited availability (23.8%), insufficient training (23.3%), and lack of awareness (20.5%) (Figure 1).OPEN IN VIEWER

Figure 1.

Main barriers to the use of robotic-assisted therapy in stroke rehabilitation (n = 210).

Discussion

This study offers one of the first insights into healthcare professionals’ awareness, perceptions, and clinical adoption of robotic-assisted therapy (RAT) for stroke rehabilitation in Saudi Arabia. Findings indicate moderate awareness and generally positive perceptions, but relatively low clinical adoption, highlighting barriers that limit RAT integration into routine practice.

The study showed that only a portion of participants had heard of RAT, and merely a few reported high understanding. These findings highlight a substantial knowledge gap, consistent with prior studies in low-to middle-income regions, where awareness of advanced rehabilitation technologies remains limited.^14,21 Similar trends have been observed globally, with awareness levels rarely exceeding moderate levels among clinicians in comparable healthcare settings.^17,22 The significant associations between awareness, age, education, and years of experience in this study align with previous evidence indicating that senior professionals and those with higher educational attainment are more likely to engage with emerging technologies.^15,23,24 Targeted educational programs-integrated into continuing medical education (CME)- could enhance familiarity with RAT’s evidence base and practical applications. ²⁵

Perceptions of RAT were generally positive, with many participants viewing it as effective and safe. This optimism mirrors findings from recent studies where healthcare workers acknowledged RAT’s potential to improve motor outcomes, reduce therapy workload, and enhance patient engagement.^3,16 However, the persistence of uncertainty-nearly one-quarter rated RAT as moderately effective or moderately safe-suggests lingering concerns about cost-effectiveness, training adequacy, and safety standards. ²⁶ These concerns may stem from limited exposure to RAT in routine practice and a lack of national guidelines supporting its implementation. Integration of evidence-based frameworks, such as the Technology Acceptance Model (TAM), has been recommended to address these perceptions, emphasizing ease of use, perceived benefit, and institutional support. ¹⁰

Despite positive perceptions, actual adoption was low, with only a portion of respondents incorporating RAT in practice-most using exoskeletons- and most reporting rare usage. This reflects a global trend where RAT remains underutilized despite promising clinical outcomes.^27,28 Barriers identified, such as high cost, limited availability, insufficient training, and lack of awareness, are consistent with previous studies highlighting financial and infrastructural constraints as primary impediments in resource-limited healthcare systems.^29,30 Cost concerns may be particularly relevant in Saudi Arabia, where advanced rehabilitation facilities remain concentrated in tertiary centers, limiting patient access and clinician exposure.^31,32 Strategies to address these barriers include government-subsidized programs, integration of RAT modules into rehabilitation curricula, and structured hands-on workshops to enhance competence and confidence in using robotic systems. ³³

Over half of the respondents believed RAT will play a pivotal role in the future of stroke rehabilitation in Saudi Arabia. This finding reflects expectations rather than confirmed implementation and should be interpreted cautiously due to the cross-sectional design and reliance on self-reported data. Although these views align with national healthcare innovation strategies, they do not necessarily indicate current readiness for widespread adoption.

This forward-looking perspective is consistent with international projections anticipating increased adoption as technologies become more accessible and cost-effective.^29,34 Participants identified improved accessibility, reduced costs, enhanced training, and awareness campaigns as key facilitators, paralleling findings from recent implementation studies in which these factors significantly predicted successful integration.^29,35 Notably, the emphasis on training aligns with evidence from multiple healthcare contexts demonstrating that clinician upskilling is associated with more favorable perceptions and a greater willingness to adopt new technologies.^12,36

Although this study was conducted in Jeddah, Saudi Arabia, the identified barriers and facilitators to robotic-assisted rehabilitation adoption are consistent with those reported in international settings, supporting the broader relevance of the findings.

This study has several limitations. First, This study used convenience sampling within selected hospitals in Jeddah, which may limit representativeness and generalizability to healthcare professionals in other regions or settings with different resources, patient populations, or exposure to robotic-assisted rehabilitation technologies. Second, the cross-sectional design precludes causal inference, and longitudinal studies are needed to examine how awareness, perceptions, and adoption of RAT evolve over time. Third, reliance on self-reported data may introduce social desirability or recall bias, potentially inflating perceived awareness or favorable perceptions. Finally, the questionnaire assessed awareness and perceptions using only two items each; qualitative approaches such as interviews or focus groups could provide deeper insights into contextual and cultural factors influencing RAT adoption.

Conclusion

Awareness of robotic-assisted therapy among healthcare professionals in Jeddah is moderate, and perceptions are generally positive; however, clinical adoption remains constrained by high costs, limited availability, insufficient training, and lack of awareness. Adoption also varies with age, experience, and professional background. These findings underscore the need for targeted policy interventions, including investment in training programs, increased accessibility of RAT, and strategies to raise awareness, to support the integration of robotic-assisted therapy into routine stroke rehabilitation in Saudi Arabia.

Future directions

Future research should employ longitudinal designs to monitor changes in awareness, perceptions, and adoption following educational or infrastructural interventions. Comparative studies across regions in Saudi Arabia and the Gulf could elucidate geographical and institutional disparities. Incorporating mixed-method approaches, including qualitative interviews, can provide nuanced insights into clinician attitudes and contextual barriers. Cost-effectiveness analyses are needed to guide policy and encourage investment in RAT technologies.