Analysis of Home-Based Rehabilitation Robotics: Lessons Learned from Nationwide Direct-to-Consumer Deployment

INTRODUCTION: Millions of stroke survivors in the US have sensory-motor impairments that significantly impact quality of life and place a long-term burden on families, communities, and the healthcare system. Neurorehabilitation aims to improve function, typically through repetitive practice of movements and task-related activities where doses are regularly titrated by skilled clinicians. Unfortunately, these highly intensive, skilled interventions are challenging to implement at the scale needed to serve the needs of stroke survivors. Rehabilitation technologies have long promised to be the workforce multiplier to normalize this large supply-demand mismatch in the U.S. healthcare system. Extensive investigations into rehabilitation devices have revealed myriad benefits. While rehab technologies have the potential to improve function, these inferences are largely derived from academic clinical studies which, while useful for exploring efficacy, do not represent marketplace (ie, commercial) conditions where interventions must operate to serve the larger population. METHODS: Here, we present data from the first nationwide direct-to-consumer deployment of 2 home-based rehabilitation robotic systems. RESULTS: Analysis of 3182 device deployments from August 2019 to June 2024 reveal surprising patterns in usage and compliance. We investigate the effects of socio-economic status, sex, rural-urban classification, and engagement on long-term utilization. Finally, we provide preliminary dose-response insights. DISCUSSION AND CONCLUSIONS: We discuss the influence of market forces on commercial delivery of care to inform stakeholders of the challenges faced translating interventions to the consumer. Overall, we aim to derive lessons that can guide future implementations and improve the inclusivity and effectiveness of rehabilitation technologies deployed at scale.