Robot-Assisted Gait Training for Adult Neurological Rehabilitation in Acute National Health Service Settings: Physiotherapists’ Perceptions Before Implementation

Objectives Integration of robotic-assisted gait training (RAGT) into acute neurological rehabilitation hinges on physiotherapists' perceptions of its value and feasibility. This study explored physiotherapists' perceptions of RAGT to identify factors influencing its acceptance prior to implementation in acute National Health Service (NHS) neurological settings. Design A qualitative study using semi-structured interviews. Data were interpreted using the Meta-Unified Theory of Acceptance and Use of Technology (Meta-UTAUT) framework to guide interview development and analysis. Setting Two secondary-care acute NHS hospital sites in England. Participants Eleven UK-registered physiotherapists working in acute neurological settings at two NHS hospital sites (eight from Site A, three from Site B; all female; clinical experience ranged 5-31 years). Results Six themes mapped to Meta-UTAUT constructs were identified. Anticipated RAGT benefits included increased training intensity, earlier mobilisation, improved patient engagement, and reduced therapists' physical burden. Perceived effort was expected to decrease with experience but remained contingent on staffing, training, and resource availability. Social and organisational influences, leadership, and professional autonomy shaped acceptance. Patient suitability, access, and equipment reliability were perceived barriers. Facilitators included leadership and prior exposure. Attitudes were positive, although concerns regarding equity and sustainability remained. Intent to use RAGT was high but varied according to job role. Conclusion Physiotherapists demonstrated cautious optimism towards RAGT, recognising benefits beyond patient outcomes to workforce wellbeing and service sustainability. Successful adoption will require structured implementation strategies, training and organisational support. Leadership and local champions may promote adoption, although implementation decisions likely remain influenced by clinicians' professional judgement and autonomy. Contribution of the Paper •Offers novel insights into acute NHS physiotherapists' perceptions of robotic-assisted gait training (RAGT) prior to implementation, addressing a notable gap in pre-implementation research within acute neurological care. •Demonstrates that anticipated benefits of RAGT extend beyond physical rehabilitation to include patient psychological outcomes and a reduced physical burden on physiotherapists, thereby broadening current understandings that typically focus on functional measures. •Highlights key requirements for successful RAGT integration, including staffing, protocol development, training, and knowledge mobilisation, while demonstrating how clinical reasoning, professional autonomy, and social influence shape decisions around patient selection and real-world use.