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.