Implementing robotic-assisted therapy in stroke rehabilitation: a structured narrative review of evidence and technology adoption barriers in Indonesia.
Abstract
Introduction Robotic-assisted therapy (RAT) has emerged as a promising intervention for post-stroke recovery; however, its implementation in developing countries such as Indonesia remains limited by economic, technical, and systemic barriers. This structured narrative review summarizes clinical effect reported by systematics review and meta-analyses and examines implementation consideration and potential economic feasibility within the Indonesian healthcare context. Method A structured review of systematic reviews and meta-analyses (2015-2025) was conducted using PubMed, Scopus, PEDro, and Cochrane Library. Studies involving adult with stroke were included. Findings were synthesized narratively because of heterogeneity. Implementation barriers were analyzed, and a scenario-based economic model was developed to assess feasibility of RAT in Indonesia. QALY-equivalent outcomes (QEOs) were estimated using ratio-based value-transfer approach that scaled published reference values according to observed functional effects. Result Evidence from 22 systematic reviews indicated that RAT improved functional outcomes compared with conventional therapy, particularly gait and upper-limb function (effect sizes: 0.02-0.52). Key implementation barriers included limited device availability, inadequate workforce training, and regulatory constraints. Modelled ICERs ranged from US$236.23-752.31 per QEO for upper-limb rehabilitation and US$558.86-4,890 per QEO for gait-related rehabilitation. Most estimates remained below the Indonesian willingness-to-pay threshold ( Conclusion RAT shows potential clinical benefits, but implementation in Indonesia should consider clinical effectiveness, economic feasibility, infrastructure, workforce, technology acceptance, and reimbursement. A phased approach in suitable tertiary-care settings may support wider adoption based on local evidence.