Clinical Uptake of Pediatric Exoskeletons: A Pilot Study Using the Consolidated Framework for Implementation Research

Abstract

Objective While the design and clinical evidence base of robot-assisted gait training (RAGT) devices has been advancing, few studies investigate user experiences with accessing and using such devices in pediatric rehabilitation. This pilot study aims to further the understanding of barriers encountered by clinicians and caregivers when implementing a RAGT device. Design A qualitative descriptive study was conducted at a local outpatient pediatric therapy center with a RAGT exoskeleton. Six caregivers and six clinicians participated in semi-structured interviews with brief surveys. The surveys were summarized with descriptive statistics. The interviews were analyzed using directed content analysis guided by the Consolidated Framework for Implementation Research (CFIR). Results The five most mentioned CFIR constructs were knowledge and beliefs, relative advantage, child attributes, complexity, and access to knowledge and information. Caregivers experienced obstacles to accessing and trialing RAGT devices. Clinicians expressed concerns regarding the feasibility of incorporating RAGT into their clinic and preferred lower-tech gait training techniques. Conclusion While some aspects of access and usability may be addressed by device design and technological advancements, overcoming other barriers will require a deeper understanding of the roles of scientific evidence, personal beliefs, and current therapy workflows in the uptake of robotic interventions.