{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,11]],"date-time":"2026-03-11T08:03:35Z","timestamp":1773216215635,"version":"3.50.1"},"reference-count":42,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2026,3,10]],"date-time":"2026-03-10T00:00:00Z","timestamp":1773100800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100003196","name":"Ministry of Health, Italy","doi-asserted-by":"publisher","award":["RRC-2026-23688274"],"award-info":[{"award-number":["RRC-2026-23688274"]}],"id":[{"id":"10.13039\/501100003196","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Post-stroke pain (PSP), particularly shoulder pain, is frequent and often underdiagnosed, limiting rehabilitation adherence and functional recovery. Current pharmacological and physical treatments offer only partial relief. Robotic-assisted therapy (RAT), such as the gravity-supporting Armeo\u00ae Spring exoskeleton, delivers intensive, task-specific training with visual 2D feedback that may also alleviate PSP while enhancing motor outcomes. This study investigates whether RAT performed with the Armeo\u00ae Spring reduces upper-limb PSP in chronic stroke patients versus conventional therapy and evaluates its effects on motor function and functional independence. Methods: In this retrospective parallel group study, 32 chronic post-stroke patients (8 females and 24 males with a mean age of 57 \u00b1 11.74) were allocated to two groups: 16 received upper-limb RAT with the Armeo\u00ae Spring, a gravity-supporting exoskeleton, (RAT group) and 16 underwent conventional rehabilitation (CR). The RAT group completed one-hour sessions 6 days\/week for 8 weeks, performing 2D\/3D gamified tasks targeting shoulder, elbow and forearm movements. The CR group received an equivalent amount of standard therapy, including passive\/active-assisted mobilization, Bobath-based neuromuscular facilitation and reaching exercises. Results: Both the Armeo\u00ae Spring and conventional therapy groups showed significant reductions in post-stroke pain (RAT p &lt; 0.001 and conventional rehabilitation p = 0.004) and improvements in upper-limb motor function and functional independence (both p \u2264 0.002). Spasticity in the impaired limb decreased modestly in the RAT group (p = 0.031), with no significant between-group differences in pain or spasticity change (p = 0.437; p &gt; 0.05, respectively). Conclusions: Gravity-support exoskeleton training reduced upper-limb spasticity, and no statistically significant between-group differences were observed compared with conventional physiotherapy for pain, mobility, and functional independence. Although clinical outcomes improved, health-related quality-of-life domains showed heterogeneous trajectories, underscoring the complexity of perceived health changes during chronic stroke rehabilitation. Larger randomized controlled trials incorporating neurophysiological and kinematic endpoints and longer follow-up are warranted to confirm effectiveness, particularly in chronic stroke and durability.<\/jats:p>","DOI":"10.3390\/jcm15062099","type":"journal-article","created":{"date-parts":[[2026,3,10]],"date-time":"2026-03-10T09:55:38Z","timestamp":1773136538000},"page":"2099","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["A Retrospective Clinical Analysis of Pain and Spasticity Outcomes Following Gravity-Support Exoskeleton Therapy in Chronic Stroke"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3284-9741","authenticated-orcid":false,"given":"Mirjam","family":"Bonanno","sequence":"first","affiliation":[{"name":"IRCCS Centro Neurolesi Bonino-Pulejo, 98124 Messina, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1812-8454","authenticated-orcid":false,"given":"Desiree","family":"Latella","sequence":"additional","affiliation":[{"name":"IRCCS Centro Neurolesi Bonino-Pulejo, 98124 Messina, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1688-2151","authenticated-orcid":false,"given":"Paolo","family":"De Pasquale","sequence":"additional","affiliation":[{"name":"IRCCS Centro Neurolesi Bonino-Pulejo, 98124 Messina, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-0057-7907","authenticated-orcid":false,"given":"Mauro","family":"Botindari","sequence":"additional","affiliation":[{"name":"IRCCS Centro Neurolesi Bonino-Pulejo, 98124 Messina, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Antonino","family":"Lombardo Facciale","sequence":"additional","affiliation":[{"name":"IRCCS Centro Neurolesi Bonino-Pulejo, 98124 Messina, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Angelo","family":"Quartarone","sequence":"additional","affiliation":[{"name":"IRCCS Centro Neurolesi Bonino-Pulejo, 98124 Messina, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9503-4366","authenticated-orcid":false,"given":"Rosaria","family":"De Luca","sequence":"additional","affiliation":[{"name":"IRCCS Centro Neurolesi Bonino-Pulejo, 98124 Messina, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3602-4197","authenticated-orcid":false,"given":"Giovanni","family":"Morone","sequence":"additional","affiliation":[{"name":"Santa Lucia Foundation, Scientific Institute for Research, Hospitalization and Health Care (IRCCS), 00179 Rome, Italy"},{"name":"Department of Life, Health and Environmental Sciences, University of L\u2019Aquila, 67100 L\u2019Aquila, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8566-3166","authenticated-orcid":false,"given":"Rocco Salvatore","family":"Calabr\u00f2","sequence":"additional","affiliation":[{"name":"IRCCS Centro Neurolesi Bonino-Pulejo, 98124 Messina, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,3,10]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"795","DOI":"10.1016\/S1474-4422(21)00252-0","article-title":"Global, Regional, and National Burden of Stroke and Its Risk Factors, 1990\u20132019: A Systematic Analysis for the Global Burden of Disease Study 2019","volume":"20","author":"Feigin","year":"2021","journal-title":"Lancet Neurol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"2418","DOI":"10.1161\/STROKEAHA.120.029606","article-title":"Burden of Stroke in Europe","volume":"51","author":"Wafa","year":"2020","journal-title":"Stroke"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"561","DOI":"10.1016\/j.mpmed.2020.06.002","article-title":"Stroke: Causes and Clinical Features","volume":"48","author":"Murphy","year":"2020","journal-title":"Medicine"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1238","DOI":"10.1161\/STROKEAHA.111.671008","article-title":"Chronic Pain Syndromes After Ischemic Stroke","volume":"44","author":"Diener","year":"2013","journal-title":"Stroke"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"329","DOI":"10.1097\/MRR.0b013e328010c7b8","article-title":"Prevalence and Predictors of Pain and Fatigue after Stroke: A Population-Based Study","volume":"29","author":"Appelros","year":"2006","journal-title":"Int. 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