Digital and robot-assisted kinesitherapy: A systematic review of clinical efficacy, safety, and translational validity compared to conventional rehabilitation

The digital transformation of health systems over the past two decades has driven a fundamental shift
in kinesitherapy rehabilitation models, with robot-assisted systems, telerehabilitation platforms, virtual and
augmented reality, wearable biosensors, and artificial intelligence algorithms creating new clinical paradigms
whose efficacy, safety, and applicability in routine clinical practice require rigorous evaluation according to the
principles of evidence-based medicine. The purpose of this systematic review was to conduct a critical
comparative analysis of the clinical efficacy, safety, and translational validity of digital and robot-assisted
rehabilitation models compared to conventional kinesitherapy, and to assess the extent to which technological
innovation translates into genuine clinical superiority. Methodologically, the research was designed as a
systematic review with critical comparative synthesis, aligned with internationally recognized guidelines for
reporting systematic reviews, with research questions structured according to population, intervention,
comparison, and outcome; the search was conducted across major biomedical and clinical literature databases
for the period 2005 to 2026, including randomized controlled trials, systematic reviews, and meta-analyses, with
methodological quality assessed using a standardized physiotherapy evidence rating scale, risk of bias evaluated
with a revised tool for randomized trials, and certainty of evidence assessed according to a structured grading
approach. Results supported by moderate-to-high quality evidence indicated that robot-assisted therapy in post
stroke patients significantly improved motor function when combined with conventional therapy, with a
standardized mean difference of 0.34 to 0.50 for upper-limb motor function and increased odds of achieving
independent walking; interventions based on virtual reality demonstrated statistically significant improvements
in functional outcomes and patient motivation; telerehabilitation showed non-inferiority relative to standard
care, with high patient satisfaction and improved accessibility; and wearable sensor systems combined with
machine learning algorithms supported objective, reproducible tracking of motor recovery, although the
certainty of this evidence remained lower due to moderate inconsistency and indirectness of the outcome
measures used. In conclusion, digital and robot-assisted kinesitherapy demonstrated clinical efficacy and a
favorable safety profile in selected populations, supported by moderate-to-high quality evidence, although the
integration of these technologies into clinical practice must be guided by clearly defined research questions,
methodological transparency, and standardization of outcome measures; multicenter randomized controlled
trials with longer follow-up periods are needed to confirm the long-term clinical and economic sustainability of
these models.