Adherence System Usability Patient Experience and Psychosocial Impact in Robot Assisted Gait Neurorehabilitation A Cross Sectional Study

Background Attendance, usability and rehabilitation experience may relate to perceived psychosocial impact in robotic neurorehabilitation. Objective To examine these associations in adults receiving robot-assisted gait neurorehabilitation, including diagnosis-adjusted and exploratory indirect associations. Methods This single-center observational study included 250 adults with stroke, spinal cord injury, multiple sclerosis or cerebral palsy. The System Usability Scale (SUS), Neurorehabilitation Experience Questionnaire (NREQ) and Psychosocial Impact of Assistive Devices Scale (PIADS) were administered in week two. Attendance covered the planned course; participation equaled attended/planned sessions × 100. Analyses included Spearman correlations, adjusted regression, indirect-association models with 5,000 bootstrap resamples, Kruskal–Wallis tests and Cronbach's alpha. Results Mean participation was 86.35 ± 8.38%. Mean SUS, NREQ and PIADS scores were 72.79 ± 12.06, 27.84 ± 4.92 and 1.67 ± 0.74, respectively. Adherence correlated with SUS (r s = 0.41), NREQ (r s = 0.49) and PIADS (r s = 0.53; all p < 0.001). After adjustment for diagnosis, age, sex and disease duration, adherence (B = 0.0145), SUS (B = 0.0210) and NREQ (B = 0.0630) remained associated with PIADS (all p < 0.001; R 2 = 0.650). The diagnosis-adjusted indirect association through NREQ was 0.0252 (95% bootstrap CI 0.0178–0.0336). Scores differed across adherence categories (all p < 0.001). Cronbach's alpha values were 0.86, 0.89 and 0.94, respectively. Conclusion Greater attendance, usability and rehabilitation experience were associated with favorable psychosocial impact. Diagnostic heterogeneity, simultaneous questionnaire assessment and temporal mismatch with attendance limit interpretation. These findings establish neither causal mediation nor functional improvement.