Validation of the Taiwan Chinese Version of the Assistive Technology Usability Questionnaire for People With Neurological Diseases for Wearable Robotic Exoskeletons: Usability Study

Background Assessing usability is important given the increasing use of technology in rehabilitation. While wearable robotic exoskeletons (WREs) are commonly incorporated into neurological rehabilitation in both clinical and community settings, there is a need to examine the applicability of different usability instruments in this context. The Assistive Technology Usability Questionnaire for People with Neurological Diseases (NATU Quest) was developed to evaluate the usability of assistive technology in individuals with neurological conditions. However, its reliability and validity have been established only for assistive devices such as wheelchairs and canes, restricting its generalizability. Objective This study aimed to cross-culturally adapt a Taiwan Chinese version of the NATU Quest and to preliminarily evaluate its applicability, reliability, and validity for assessing WRE use among patients who had a stroke as an expanding application context. Methods Cross-cultural adaptation was achieved through a structured translation from Spanish to Taiwan Chinese, followed by content validation by an expert panel of 10 raters. Following the adaptation process, psychometric testing of the NATU Quest was administered to 20 patients who had a stroke following the completion of a comprehensive course of robot-assisted gait training facilitated by a WRE. The internal consistency of the NATU Quest was evaluated using the Cronbach α coefficient. The reliability of the test-retest procedure was evaluated using the intraclass correlation coefficient (ICC). Convergent validity was ascertained by examining the correlation between the NATU Quest scores and the System Usability Scale (SUS). Results The culturally adapted NATU Quest showed acceptable content validity, with item-level content validity index (CVI) values ranging from 0.80 to 1.00 and scale-level CVI values of 0.93 for clarity and 0.97 for relevance. Cronbach α was 0.943, indicating high internal consistency. Of the 20 participants who completed all 6 rehabilitation sessions, 13 participants completed repeat testing. Preliminary test-retest reliability was acceptable (ICC=0.823; P <.001; SE of measurement=0.31). NATU Quest scores were strongly correlated with SUS scores (Spearman ρ=0.818; P <.001), providing preliminary support for convergent validity. Conclusions The adapted NATU Quest demonstrated promising preliminary psychometric properties when applied to WRE use among individuals who had a stroke. Further studies with larger sample sizes are warranted to examine additional psychometric properties such as construct validity and responsiveness.