{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T21:54:11Z","timestamp":1787003651253,"version":"build-2736575974"},"reference-count":41,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2025,11,19]],"date-time":"2025-11-19T00:00:00Z","timestamp":1763510400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"},{"start":{"date-parts":[[2025,11,19]],"date-time":"2025-11-19T00:00:00Z","timestamp":1763510400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"}],"funder":[{"DOI":"10.13039\/501100003407","name":"Ministero dell\u2019Istruzione, dell\u2019Universit\u00e0 e della Ricerca","doi-asserted-by":"publisher","award":["PNC0000007"],"award-info":[{"award-number":["PNC0000007"]}],"id":[{"id":"10.13039\/501100003407","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Sci Rep"],"DOI":"10.1038\/s41598-025-24656-7","type":"journal-article","created":{"date-parts":[[2025,11,19]],"date-time":"2025-11-19T12:08:02Z","timestamp":1763554082000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Breaking down costs: rehabilitation robotics vs. usual care therapy in diverse healthcare models"],"prefix":"10.1038","volume":"15","author":[{"given":"Valerio","family":"Gower","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Taya","family":"Hamilton","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Federico","family":"Spinelli","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mattia","family":"Randazzo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Irene Giovanna","family":"Aprile","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesca","family":"Falchini","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marco","family":"Germanotta","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Furio","family":"Gramatica","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Todd","family":"Wagner","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hermano Igo","family":"Krebs","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,11,19]]},"reference":[{"key":"24656_CR1","doi-asserted-by":"publisher","first-page":"412","DOI":"10.3389\/fneur.2019.00412","volume":"10","author":"C Duret","year":"2019","unstructured":"Duret, C., Grosmaire, A.-G. & Krebs, H. I. Robot-Assisted therapy in upper extremity hemiparesis: Overview of an evidence-based approach. Front. Neurol. 10, 412 (2019).","journal-title":"Front. Neurol."},{"key":"24656_CR2","doi-asserted-by":"publisher","DOI":"10.1682\/JRRD.2005.04.0076","author":"GB Prange","year":"2006","unstructured":"Prange, G. B., Jannink, M. J. A., Groothuis-Oudshoorn, C. G. M., Hermens, H. J. & Ijzerman, M. J. Systematic review of the effect of robot-aided therapy on recovery of the hemiparetic arm after stroke. J. Rehabil. Res. Dev. https:\/\/doi.org\/10.1682\/JRRD.2005.04.0076 (2006).","journal-title":"J. Rehabil. Res. Dev."},{"key":"24656_CR3","doi-asserted-by":"publisher","DOI":"10.1044\/1092-4388(2008\/018)","author":"JA Kleim","year":"2008","unstructured":"Kleim, J. A. & Jones, T. A. Principles of experience-dependent neural plasticity: Implications for rehabilitation after brain damage. J. Speech, Language, Hearing Res. https:\/\/doi.org\/10.1044\/1092-4388(2008\/018) (2008).","journal-title":"J. Speech, Language, Hearing Res."},{"key":"24656_CR4","doi-asserted-by":"publisher","DOI":"10.1093\/brain\/awr039","author":"SC Cramer","year":"2011","unstructured":"Cramer, S. C. et al. Harnessing neuroplasticity for clinical applications. Brain https:\/\/doi.org\/10.1093\/brain\/awr039 (2011).","journal-title":"Brain"},{"key":"24656_CR5","doi-asserted-by":"publisher","first-page":"312","DOI":"10.1007\/s40141-016-0139-0","volume":"4","author":"J Laut","year":"2016","unstructured":"Laut, J., Porfiri, M. & Raghavan, P. The present and future of robotic technology in rehabilitation. Curr. Phys. Med. Rehabil. Rep. 4, 312\u2013319 (2016).","journal-title":"Curr. Phys. Med. Rehabil. Rep."},{"key":"24656_CR6","first-page":"1","volume":"3","author":"R Riener","year":"2013","unstructured":"Riener, R. Rehabilitation robotics. Found. Trends\u00ae Robot. 3, 1\u2013137 (2013).","journal-title":"Found. Trends\u00ae Robot."},{"key":"24656_CR7","doi-asserted-by":"publisher","first-page":"723","DOI":"10.1682\/JRRD.2005.02.0048","volume":"42","author":"JJ Daly","year":"2005","unstructured":"Daly, J. J. et al. Response to upper-limb robotics and functional neuromuscular stimulation following stroke. J. Rehabil. Res. Dev. 42, 723\u2013736 (2005).","journal-title":"J. Rehabil. Res. Dev."},{"key":"24656_CR8","doi-asserted-by":"publisher","first-page":"1772","DOI":"10.1056\/NEJMoa0911341","volume":"362","author":"AC Lo","year":"2010","unstructured":"Lo, A. C. et al. Robot-Assisted therapy for long-term upper-limb impairment after stroke. N. Engl. J. Med. 362, 1772\u20131783 (2010).","journal-title":"N. Engl. J. Med."},{"key":"24656_CR9","doi-asserted-by":"publisher","first-page":"3","DOI":"10.1097\/NPT.0000000000000295","volume":"44","author":"I Aprile","year":"2020","unstructured":"Aprile, I. et al. Upper limb robotic rehabilitation after stroke: A multicenter, randomized clinical trial. J. Neurol. Phys. Ther. 44, 3\u201314 (2020).","journal-title":"J. Neurol. Phys. Ther."},{"key":"24656_CR10","doi-asserted-by":"publisher","first-page":"51","DOI":"10.1016\/S0140-6736(19)31055-4","volume":"394","author":"H Rodgers","year":"2019","unstructured":"Rodgers, H. et al. Robot assisted training for the upper limb after stroke (RATULS): A multicentre randomised controlled trial. Lancet 394, 51\u201362 (2019).","journal-title":"Lancet"},{"key":"24656_CR11","doi-asserted-by":"publisher","first-page":"583","DOI":"10.1177\/1545968315608448","volume":"30","author":"X Wu","year":"2016","unstructured":"Wu, X., Guarino, P., Lo, A. C., Peduzzi, P. & Wininger, M. Long-term effectiveness of intensive therapy in chronic stroke. Neurorehabil. Neural Repair 30, 583\u2013590 (2016).","journal-title":"Neurorehabil. Neural Repair"},{"key":"24656_CR12","doi-asserted-by":"publisher","first-page":"3049","DOI":"10.11124\/JBISRIR-2017-003456","volume":"15","author":"K Lo","year":"2017","unstructured":"Lo, K., Stephenson, M. & Lockwood, C. Effectiveness of robotic assisted rehabilitation for mobility and functional ability in adult stroke patients: A systematic review. JBI Database Syst. Rev. Implement. Rep. 15, 3049\u20133091 (2017).","journal-title":"JBI Database Syst. Rev. Implement. Rep."},{"key":"24656_CR13","first-page":"CD006876","volume":"9","author":"J Mehrholz","year":"2018","unstructured":"Mehrholz, J., Pohl, M., Platz, T., Kugler, J. & Elsner, B. Electromechanical and robot-assisted arm training for improving activities of daily living, arm function, and arm muscle strength after stroke. Cochrane Database Syst. Rev. 9, CD006876 (2018).","journal-title":"Cochrane Database Syst. Rev."},{"key":"24656_CR14","doi-asserted-by":"publisher","DOI":"10.1093\/ptj\/pzab010","author":"J Wu","year":"2021","unstructured":"Wu, J., Cheng, H., Zhang, J., Yang, S. & Cai, S. Robot-Assisted therapy for upper extremity motor impairment after stroke: A systematic review and meta-analysis. Phys. Therapy. https:\/\/doi.org\/10.1093\/ptj\/pzab010 (2021).","journal-title":"Phys. Therapy."},{"key":"24656_CR15","doi-asserted-by":"publisher","DOI":"10.1016\/j.apmr.2023.02.004","author":"X Yang","year":"2023","unstructured":"Yang, X., Shi, X., Xue, X. & Deng, Z. Efficacy of robot-assisted training on rehabilitation of upper limb function in patients with stroke: A systematic review and meta-analysis. Arch. Phys. Med. Rehabil. https:\/\/doi.org\/10.1016\/j.apmr.2023.02.004 (2023).","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"24656_CR16","doi-asserted-by":"publisher","first-page":"885","DOI":"10.1016\/j.jval.2016.03.2003","volume":"19","author":"K Claxton","year":"2016","unstructured":"Claxton, K. et al. A comprehensive algorithm for approval of health technologies with, without, or only in research: The key principles for informing coverage decisions. Value Health 19, 885\u2013891 (2016).","journal-title":"Value Health"},{"key":"24656_CR17","doi-asserted-by":"publisher","first-page":"1445099","DOI":"10.3389\/fpubh.2024.1445099","volume":"12","author":"V Gower","year":"2024","unstructured":"Gower, V. et al. Cost analysis of technological vs. conventional upper limb rehabilitation for patients with neurological disorders: An Italian real-world data case study. Front. Public Health 12, 1445099 (2024).","journal-title":"Front. Public Health"},{"key":"24656_CR18","first-page":"265634","volume":"2014","author":"S Masiero","year":"2014","unstructured":"Masiero, S. et al. Robotic upper limb rehabilitation after acute stroke by NeReBot: Evaluation of treatment costs. Biomed. Res. Int. 2014, 265634 (2014).","journal-title":"Biomed. Res. Int."},{"key":"24656_CR19","doi-asserted-by":"publisher","first-page":"770259","DOI":"10.3389\/fneur.2022.770259","volume":"13","author":"O Pila","year":"2022","unstructured":"Pila, O., Koeppel, T., Grosmaire, A. G. & Duret, C. Impact of dose of combined conventional and robotic therapy on upper limb motor impairments and costs in subacute stroke patients: A retrospective study. Front. Neurol. 13, 770259 (2022).","journal-title":"Front. Neurol."},{"key":"24656_CR20","doi-asserted-by":"publisher","first-page":"2630","DOI":"10.1161\/STROKEAHA.110.606442","volume":"42","author":"TH Wagner","year":"2011","unstructured":"Wagner, T. H. et al. An economic analysis of robot-assisted therapy for long-term upper-limb impairment after stroke. Stroke; A J. Cerebral Circ. 42, 2630\u20132632 (2011).","journal-title":"Stroke; A J. Cerebral Circ."},{"key":"24656_CR21","doi-asserted-by":"publisher","first-page":"5357","DOI":"10.1109\/86.662623","volume":"6","author":"HI Krebs","year":"1998","unstructured":"Krebs, H. I., Hogan, N., Aisen, M. L. & Volpe, B. T. Robot-aided neurorehabilitation. IEEE Trans. Rehabil. Eng. 6, 5357 (1998).","journal-title":"IEEE Trans. Rehabil. Eng."},{"key":"24656_CR22","doi-asserted-by":"crossref","unstructured":"Aprile, I. et al. Improving the efficiency of robot-mediated rehabilitation by using a new organizational model: An observational feasibility study in an Italian rehabilitation center. 9, (2019).","DOI":"10.3390\/app9245357"},{"key":"24656_CR23","doi-asserted-by":"publisher","first-page":"23","DOI":"10.1186\/s12916-021-02204-0","volume":"20","author":"D Husereau","year":"2022","unstructured":"Husereau, D. et al. Consolidated health economic evaluation reporting standards 2022 (CHEERS 2022) statement: Updated reporting guidance for health economic evaluations. BMC Med. 20, 23 (2022).","journal-title":"BMC Med."},{"key":"24656_CR24","doi-asserted-by":"publisher","first-page":"1135","DOI":"10.1007\/s40273-020-00942-2","volume":"38","author":"DD Kim","year":"2020","unstructured":"Kim, D. D. et al. Perspective and costing in cost-effectiveness analysis, 1974\u20132018. Pharmacoeconomics 38, 1135\u20131145 (2020).","journal-title":"Pharmacoeconomics"},{"key":"24656_CR25","doi-asserted-by":"publisher","first-page":"1093","DOI":"10.1001\/jama.2016.12195","volume":"316","author":"GD Sanders","year":"2016","unstructured":"Sanders, G. D. et al. Recommendations for conduct, methodological practices, and reporting of cost-effectiveness analyses. JAMA 316, 1093\u20131103 (2016).","journal-title":"JAMA"},{"key":"24656_CR26","unstructured":"Drummond, M. F., Sculpher, M. J., Claxton, K., Stoddart, G. L. & Torrance, G. W. Methods for the Economic Evaluation of Health Care Programmes. (Oxford university press, 2015)."},{"key":"24656_CR27","doi-asserted-by":"publisher","DOI":"10.1007\/978-3-319-15744-3","author":"R Edlin","year":"2015","unstructured":"Edlin, R., McCabe, C., Hulme, C., Hall, P. & Wright, J. Cost effectiveness modelling for health technology assessment. Cost Eff. Model. Health Technol. Assess. https:\/\/doi.org\/10.1007\/978-3-319-15744-3 (2015).","journal-title":"Cost Eff. Model. Health Technol. Assess."},{"key":"24656_CR28","unstructured":"National Institute for Health and Care Excellence. NICE Health Technology Evaluations: The Manual. Process and Methods [PMG36]. National Institute for Health and Care Excellence (2022)."},{"key":"24656_CR29","doi-asserted-by":"publisher","DOI":"10.1186\/s13561-024-00523-5","author":"KA Agbemanyole","year":"2024","unstructured":"Agbemanyole, K. A. et al. Economic analysis of digital motor rehabilitation technologies: A systematic review. Health Econ. Rev. https:\/\/doi.org\/10.1186\/s13561-024-00523-5 (2024).","journal-title":"Health Econ. Rev."},{"key":"24656_CR30","doi-asserted-by":"publisher","first-page":"1531","DOI":"10.3390\/jcm13061531","volume":"13","author":"R Cano-de-la-Cuerda","year":"2024","unstructured":"Cano-de-la-Cuerda, R. et al. Economic cost of rehabilitation with robotic and virtual reality systems in people with neurological disorders: A systematic review. J. Clin. Med. 13, 1531 (2024).","journal-title":"J. Clin. Med."},{"key":"24656_CR31","doi-asserted-by":"publisher","first-page":"e042081","DOI":"10.1136\/bmjopen-2020-042081","volume":"11","author":"C Fernandez-Garcia","year":"2021","unstructured":"Fernandez-Garcia, C. et al. Economic evaluation of robot-assisted training versus an enhanced upper limb therapy programme or usual care for patients with moderate or severe upper limb functional limitation due to stroke: Results from the RATULS randomised controlled trial. BMJ Open 11, e042081 (2021).","journal-title":"BMJ Open"},{"key":"24656_CR32","doi-asserted-by":"publisher","first-page":"775","DOI":"10.1177\/1545968309338195","volume":"23","author":"AC Lo","year":"2009","unstructured":"Lo, A. C. et al. Multicenter randomized trial of robot-assisted rehabilitation for chronic stroke: Methods and entry characteristics for VA ROBOTICS. Neurorehabil. Neural Repair 23, 775\u2013783 (2009).","journal-title":"Neurorehabil. Neural Repair"},{"key":"24656_CR33","doi-asserted-by":"publisher","first-page":"327","DOI":"10.1109\/TNSRE.2007.903899","volume":"15","author":"HI Krebs","year":"2007","unstructured":"Krebs, H. I. et al. Robot-aided neurorehabilitation: A robot for wrist rehabilitation. IEEE Trans. Neural Syst. Rehabil. Eng. 15, 327\u2013335 (2007).","journal-title":"IEEE Trans. Neural Syst. Rehabil. Eng."},{"key":"24656_CR34","doi-asserted-by":"publisher","first-page":"3920","DOI":"10.3390\/app9183920","volume":"9","author":"Aprile","year":"2019","unstructured":"Aprile, et al. Upper limb robotics in rehabilitation: An approach to select the devices, based on rehabilitation aims, and their evaluation in a feasibility study. Appl. Sci. 9, 3920 (2019).","journal-title":"Appl. Sci."},{"key":"24656_CR35","doi-asserted-by":"publisher","first-page":"934","DOI":"10.3109\/09638288.2016.1163422","volume":"39","author":"CB Lundquist","year":"2017","unstructured":"Lundquist, C. B. & Maribo, T. The Fugl-Meyer assessment of the upper extremity: Reliability, responsiveness and validity of the Danish version. Disabil. Rehabil. 39, 934\u2013939 (2017).","journal-title":"Disabil. Rehabil."},{"key":"24656_CR36","unstructured":"Shirley Ryan AbilityLab. Rehabilitation Measures Database. https:\/\/www.sralab.org\/rehabilitation-measures."},{"key":"24656_CR37","doi-asserted-by":"publisher","unstructured":"Purchasing Power Parities and the Size of World Economies: Results from the 2017 International Comparison Program. https:\/\/doi.org\/10.1596\/978-1-4648-1530-0 (2020).","DOI":"10.1596\/978-1-4648-1530-0"},{"key":"24656_CR38","doi-asserted-by":"publisher","first-page":"143","DOI":"10.1109\/RBME.2014.2300234","volume":"7","author":"G Turchetti","year":"2014","unstructured":"Turchetti, G. et al. Why effectiveness of robot-mediated neurorehabilitation does not necessarily influence its adoption. IEEE Rev. Biomed. Eng. 7, 143\u2013153 (2014).","journal-title":"IEEE Rev. Biomed. Eng."},{"key":"24656_CR39","doi-asserted-by":"publisher","first-page":"193","DOI":"10.1016\/S0951-8320(00)00108-3","volume":"72","author":"E Borgonovo","year":"2001","unstructured":"Borgonovo, E. & Apostolakis, G. E. A new importance measure for risk-informed decision making. Reliab. Eng. Syst. Saf. 72, 193\u2013212 (2001).","journal-title":"Reliab. Eng. Syst. Saf."},{"key":"24656_CR40","doi-asserted-by":"publisher","first-page":"17","DOI":"10.1016\/S0925-5273(03)00213-5","volume":"90","author":"E Borgonovo","year":"2004","unstructured":"Borgonovo, E. & Peccati, L. Sensitivity analysis in investment project evaluation. Int. J. Prod. Econ. 90, 17\u201325 (2004).","journal-title":"Int. J. Prod. Econ."},{"key":"24656_CR41","doi-asserted-by":"publisher","first-page":"1079","DOI":"10.1001\/jamaneurol.2019.1604","volume":"76","author":"SC Cramer","year":"2019","unstructured":"Cramer, S. C. et al. Efficacy of home-based telerehabilitation vs in-clinic therapy for adults after stroke: A randomized clinical trial. JAMA Neurol 76, 1079\u20131087 (2019).","journal-title":"JAMA Neurol"}],"container-title":["Scientific Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.nature.com\/articles\/s41598-025-24656-7.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41598-025-24656-7","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41598-025-24656-7.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,19]],"date-time":"2025-11-19T12:08:05Z","timestamp":1763554085000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.nature.com\/articles\/s41598-025-24656-7"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11,19]]},"references-count":41,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["24656"],"URL":"https:\/\/doi.org\/10.1038\/s41598-025-24656-7","relation":{},"ISSN":["2045-2322"],"issn-type":[{"value":"2045-2322","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,11,19]]},"assertion":[{"value":"11 June 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"14 October 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"19 November 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"H.I.K. is co-inventor of the MIT-held patents for the robotic device used to treat patients in this work. He is the founder of Interactive Motion Technologies (sold in 2016 to Bionik Laboratories) and he is also the founder of 4Motion Robotics. T.H. receives consulting income from 4Motion Robotics Inc. The remaining authors declare no competing interests.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"40720"}}