{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,21]],"date-time":"2026-05-21T22:08:41Z","timestamp":1779401321539,"version":"3.53.1"},"reference-count":15,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,5,21]],"date-time":"2026-05-21T00:00:00Z","timestamp":1779321600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Neurol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Stroke remains a leading cause of long-term disability globally, with upper limb impairment persisting in 39% of survivors at six months. The post-acute rehabilitation gap, characterized by precipitous decline in therapy intensity after hospital discharge, compromises recovery during critical neuroplastic windows. While robot-aided therapy (RAT) demonstrates efficacy comparable to conventional therapy, widespread implementation remains limited by cost, complexity, and facility-based care models. Home-based, minimally supervised RAT with telemonitoring could address these barriers while providing intensive therapy without proportional increases in healthcare resources.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To evaluate the feasibility, acceptability, clinical effectiveness, and cost-effectiveness of home-based minimally supervised RAT using a portable planar robot in patients with moderate upper limb impairment following stroke.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This pragmatic, single-arm, multi-center prospective trial will recruit 54 adults with subacute to chronic stroke (&amp;gt;28\u202fdays post-event) with upper extremity impairment (Fugl-Meyer Assessment 10\u201360) across three tertiary rehabilitation centers in Singapore. The intervention comprises four weeks of intensive home-based, caregiver-supervised training using the H-Man robot (60\u2013120\u202fmin daily) with weekly telemonitoring, combined with four conventional occupational therapy sessions over an eight-week treatment period. The primary outcome is utilization rate (\u226575% compliance) measured by cloud-based metrics. Secondary outcomes include motor impairment (FMA-UE), functional capacity (ARAT), quality of life (EQ-5D-5L), usability (System Usability Scale), and technology acceptance, assessed at baseline, 6, 8, 12, and 24\u202fweeks. Economic evaluation will assess cost-effectiveness from healthcare system and societal perspectives.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Recruitment commenced October 2024 across three Singapore rehabilitation hospitals. The study employs rigorous safety monitoring, standardized training protocols, and cloud-based performance tracking. Preliminary feasibility testing demonstrates acceptable device usability and caregiver support requirements.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>TRUST addresses critical gaps in post-stroke rehabilitation by evaluating a scalable model combining technology-enabled home therapy with remote clinical oversight. Results will inform implementation strategies for integrating home-RAT into standard care pathways, potentially transforming stroke rehabilitation delivery in resource-constrained healthcare systems facing growing demand from aging populations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Clinical trial registration<\/jats:title>\n                    <jats:p>\n                      <jats:ext-link>ClinicalTrials.gov<\/jats:ext-link>\n                      , identifier NCT06270459.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fneur.2026.1775829","type":"journal-article","created":{"date-parts":[[2026,5,21]],"date-time":"2026-05-21T21:11:10Z","timestamp":1779397870000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Telerehabilitation robotics for upper limb rehabilitation after stroke (TRUST): a multi-site pragmatic trial 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