Effectiveness and acceptance of assistive technologies for people with tetraplegia: A systematic review

Abstract

Individuals with tetraplegia rely on assistive devices to perform Activities of Daily Living (ADLs) and enhance independence. This review evaluates their effectiveness and user acceptance for supporting independence. A systematic literature search was conducted across seven databases from September 2004–2024 (PROSPERO: CRD42022370351). Studies evaluating assistive devices in experimental or real-world settings with individuals with tetraplegia that reported performance (task achievement) and perception (user experience) outcomes were included. Risk of bias was assessed with the Downs and Black checklist modified for nonintervention studies. From 1,670 initial records, 34 articles met inclusion criteria, involving 366 participants. Robotic arms, wearable exoskeletons, computer interfaces, powered wheelchairs, and functional electrical stimulation systems demonstrated varying effectiveness. Performance outcomes were often task-specific, and perception depended on ease of use, comfort, and adaptability. Few studies measured impact on quality of life or long-term adoption. Invasive technologies showed promising results but faced adoption barriers related to complexity and aesthetics. Heterogeneity prevented meta-analysis. While some assistive technologies improve independence, better usability and customization are needed for wider adoption. Technologies must offer substantial improvements to justify adaptation efforts. Reporting should be clearer and more standardized to facilitate comparison. Demographic biases (overrepresentation of spinal cord injury, global north, and males) limited generalizability.