Limitations
left-sided impairments, stroke
STROKE
Due to the prototype stage, the RobExReha system was only available for training of the right arm, which led to limitations in patient inclusion. The Reference Group, contrarily, additionally included patients with left-sided impairments. This could lead to bias; for example, in stroke patients, as the affected hemisphere influences the symptoms. Additionally, regarding the questionnaire evaluation, only patients with good cognitive abilities were enrolled in the study, which does not reflect the wide variation of neurological patients potentially training with robotic devices.Another possible risk of bias arises as this study was not blinded and the patients, therapists and assessors were aware of which system they were evaluating. Due to shortages in personnel resources, sometimes a participant had to act as both an assessor and administering therapist, potentially leading to biased results in the questionnaires. However, given that this was a first proof-of-concept study, we consider the risk to be acceptable.Further, regarding the study design as proof-of-concept study, no conclusions on efficacy of this type of therapy can be made.