Rehabilitation Robotics and Allied Digital Technologies: Opportunities, Barriers and Solutions for improving their clinical implementation. A Position Paper from the Fit for Medical Robotics Initiative

Irene Giovanna Aprile^1*SILVANA QUAGLINI²Giuseppe Turchetti³Leandro Pecchia^4,5Giovanni Comandè³Furio Gramatica⁶Emanuele Gruppioni⁷Giuseppina Sgandurra^8,9Christian Cipriani¹⁰

• ¹IRCCS Don Carlo Gnocchi Firenze, Florence, Tuscany, Italy
• ²Department of Electrical, Computer and Biomedical Engineering, University of Pavia, Pavia, Lombardy, Italy
• ³Sant'Anna School of Advanced Studies, Pisa, Tuscany, Italy
• ⁴School of Engineering, University of Warwick, Coventry, United Kingdom
• ⁵Department of Engineering, Università Campus Bio-Medico di Roma, Rome, Sicily, Italy
• ⁶Fondazione Don Carlo Gnocchi Onlus (IRCCS), Milan, Lombardy, Italy
• ⁷Research and Training Area of the INAIL Prosthetics, Centro Protesi INAIL, Istituto Nazionale Assicurazione contro gli Infortuni sul Lavoro, Bologna, Italy
• ⁸Department of Developmental Neuroscience, Stella Maris Scientific Institute, University of Pisa, Pisa, Tuscany, Italy
• ⁹Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Tuscany, Italy
• ¹⁰Institute of BioRobotics, Sant'Anna School of Advanced Studies, Pontedera, Italy

Robotics has been proposed as a promising solution for treating individuals with motor, sensory, and/or cognitive disabilities. Despite the great technological effort put into this field, the translation of robots from the laboratory to the clinical environment is not a seamless and smooth process, and their realworld adoption remains limited.Several barriers to the introduction of robotics in clinical practice have been identified, including a lack of sufficient scientific evidence about its actual cost/effectiveness, cultural resistance to adopting these technologies, and economic, ethical, and regulatory restraints.Fit for Medical Robotics (Fit4MedRob) is an ambitious Initiative designed to bridge the gap between technological innovation and clinical application. One of the main goals of the Initiative is to conduct large-scale pragmatic trials to evaluate the effectiveness and the sustainability of commercially available robotic solutions. Before To guide the designing design of these trialsthe trials, different online surveys have been implemented and delivered to identify the needs of healthcare practitioners and patients at different phases of the disease (acute to chronic) and therapeutic settings (hospital to home care). Users's need understanding was then used to inform trial design. The results of the Initiative will suggest new organisational organizational models to effectively introduce roboticsassisted rehabilitation into clinical practice.The paper will report on the opportunities of robotics for rehabilitation, the barriers to their clinical implementation, and the proposal of Fit4MedRob to overcome such limitations and facilitate the effective clinical implementation of robotic solutions.