Acceptability of Rehabilitation Exoskeleton from the Perspective of Users with Spinal Cord Injury and Healthcare Professionals: a Mixed Methods Systematic Review

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Abstract
Objective The objective was to document the acceptability of rehabilitation exoskeletons from the perspective of users with spinal cord injury (SCI) and healthcare professionals (HP). Methods This mixed-methods systematic review considered quantitative, qualitative and mixed methods studies that included adults with SCI using an exoskeleton for gait rehabilitation, as well as HP working within rehabilitation settings with individuals with SCI who used an exoskeleton. A convergent integrated approach per the Joanna Briggs Institute (JBI) was used. Results A total of 22 studies were included. Overall, individuals with SCI and HP expressed a favorable level of acceptability. Participants reported a positive affective attitude, an overall satisfaction, and several psychological benefits. Few burdens, ethical issues and opportunity costs have also been reported in the studies. Maintaining realistic expectations towards exoskeleton use and ensuring the appropriate selection of users is important for intervention coherence. In general, there was a positive perception regarding effectiveness and self-efficacy. Nevertheless, only a limited number of studies focused primarily on measuring acceptability, revealing an important gap in the literature. Conclusions The acceptability of exoskeletons among people with SCI and HP tends to be positive, which is promising for the sustainable implementation of this technology. However, there is still a lack of knowledge about the acceptability of HP, with only two studies conducted among this population. It is crucial to persevere in documenting the acceptability of exoskeletons, notably by standardizing comprehensive approaches for measuring acceptability, and to continue refining this technology.

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