Kinesiophobia and functional outcomes in inpatient post-stroke rehabilitation with and without robot-assisted gait therapy.

Introduction: Stroke rehabilitation aims to improve functional independence, ambulation, motor recovery, and participation in daily life. Robot-assisted gait therapy (RAGT) is increasingly used as an adjunct to conventional rehabilitation; however, its additional contribution to functional outcomes and kinesiophobia remains uncertain. This study evaluated changes in activities of daily living, ambulation, motor recovery, and kinesiophobia in patients undergoing inpatient post-stroke rehabilitation and compared routine multidisciplinary inpatient rehabilitation with the same rehabilitation approach plus additional RAGT. Methods: In this non-randomized observational comparative study, 99 post-stroke patients completed a 4-week inpatient rehabilitation program. Patients receiving routine multidisciplinary inpatient rehabilitation, including a standardized physiotherapy program, were classified as the CRTx group, whereas those receiving the same rehabilitation approach with additional RAGT were classified as the CRTx+RAGT group. Functional independence was assessed using the Barthel Index, which was defined as the primary outcome. Secondary outcomes included Functional Ambulation Classification (FAC), Brunnstrom stages, and Tampa Scale for Kinesiophobia (TSK). Assessments were performed at baseline and post-treatment. Within-group changes, between-group change scores, and adjusted linear regression models were analyzed. Results: Both groups showed significant within-group improvements in Brunnstrom stages, Barthel Index, FAC, and TSK scores after rehabilitation. In unadjusted change-score comparisons, improvements in the Barthel Index and FAC were greater in the CRTx+RAGT group, whereas changes in Brunnstrom stages and TSK scores did not differ significantly between groups. However, after adjustment for baseline score, stroke duration, education level, and baseline Brunnstrom lower-extremity stage, rehabilitation group was not independently associated with post-treatment Barthel Index, FAC, or TSK scores. Conclusion: A 4-week inpatient rehabilitation program was associated with improvements in motor recovery, functional independence, ambulation, and kinesiophobia in post-stroke patients. Although greater unadjusted improvements in Barthel Index and FAC were observed in the CRTx+RAGT group, these differences were not confirmed in adjusted analyses. The independent contribution of RAGT should therefore be interpreted cautiously and investigated further in randomized, adequately powered, and dose-matched studies.