Perceptions, attitudes, and lived experiences of therapists with lower limb robotic exoskeletons in stroke rehabilitation: a systematic review of qualitative studies.

PURPOSE To systematically review and synthesize qualitative evidence on therapists' perceptions, attitudes, and lived experiences with lower limb robotic exoskeletons in stroke rehabilitation settings. METHODS Seven databases (PsycINFO, Embase, Scopus, Web of Science, PubMed, MEDLINE, CINAHL) were searched from inception to March 2025. Study quality was assessed using the Critical Appraisal Skills Program (CASP) checklist. Thematic synthesis was employed with confidence assessed using GRADE-CERQual. RESULTS Ten studies met inclusion criteria, representing 157 therapists across nine countries. Four major themes emerged: (1) Clinical benefits and therapeutic potential - including significant reduction in physical demands and enhanced treatment capabilities (40-fold increase in step repetitions); (2) Implementation challenges and barriers - notably time constraints (15-40 min setup), prohibitive costs ($33,000-$250,000 USD), and restrictive patient eligibility; (3) Professional adaptation and identity - encompassing role tensions and competency development; (4) Integration into rehabilitation practice - with universal consensus that exoskeletons should complement rather than replace conventional therapy. High confidence was found in 60% of key findings. CONCLUSIONS While therapists recognize substantial benefits of lower limb robotic exoskeletons, significant barriers limit routine implementation. Successful integration requires comprehensive training, adequate resources, organizational support, and preservation of clinical reasoning. PROSPERO REGISTRATION CRD42024602812.