Technology Enabled Dose Optimization in Stroke Rehabilitation: A Systematic Evidence Synthesis of Intensity, Timing, and Functional Recovery

Abstract— Technology-assisted rehabilitation is increasingly used to deliver, monitor, andindividualize physiotherapy after stroke, yet the optimal therapeutic dose and the conditions underwhich additional rehabilitation produces meaningful functional benefit remain uncertain. Thissystematic evidence synthesis examined the relationship between rehabilitation dose, intensity, timing,and functional recovery, with particular attention to technology-mediated approaches including robotictraining, telerehabilitation, neuroanimation, and electromechanical-assisted gait training. A structuredmulti-source search identified approximately 4,200 unique records; 199 sources were fully extractedand 30 studies were selected for detailed synthesis. The focused dataset included randomized trials,observational cohorts, systematic reviews/meta-analyses, a guideline, a prognostic study, a trialprotocol, and a methodology paper. Because the primary studies differed substantially in populations,dose metrics, and outcomes, narrative synthesis was combined with an exploratory random-effectsanalysis of eight standardized mean differences reported across five meta-analyses. The pooled effectwas SMD 0.285 (95% CI 0.183–0.386; p<0.0001), with moderate heterogeneity (I²=49.4%). Theevidence supports a non-linear, threshold-and-plateau dose–response pattern. Technology-mediatedinterventions did not consistently outperform conventional rehabilitation when therapeutic dose wasmatched; however, robotic/electromechanical gait training and structured telerehabilitation providescalable mechanisms for delivering higher or more measurable doses in selected populations. Timingwas a critical moderator, with excessive very-early mobilization associated with poorer outcomes,while appropriately timed intensive therapy produced meaningful gains in subacute and chronicphases. These findings support response-adaptive rehabilitation systems that combine dose monitoring,patient stratification, and technology-assisted delivery rather than assuming that greater intensity aloneis universally beneficial.