# Assistive Robotic Arm to Support Activities of Daily Living in Individuals With Tetraplegia: Protocol for a Real-World Convergent Parallel Mixed Methods Feasibility Study

## TL;DR

This study explores how a robotic arm mounted on a wheelchair can help people with tetraplegia perform daily tasks and improve their quality of life.

## Contribution

The novel contribution is a real-world feasibility study of a robotic arm for tetraplegia, combining usability and economic analysis.

## Key findings

- The study will assess task performance, user experience, and cost-effectiveness of a robotic arm in real-life settings.
- Qualitative and quantitative data will be combined to evaluate feasibility and health economic outcomes.
- Results may inform future development and adoption of assistive robotic technologies for tetraplegia.

## Abstract

Tetraplegia, often resulting from cervical spinal cord injury, may lead to significant motor and sensory loss, severely impacting independence and quality of life (QoL). Assistive technologies, such as wheelchair-mounted robotic arms (WMRAs), offer potential to enhance autonomy in daily living. However, adoption remains limited due to high costs, complex controls, and insufficient end user involvement. Robust evidence on their real-world effectiveness, particularly post hospitalization, is still lacking.

This study aims to explore the feasibility, usability, and user experience of a WMRA for individuals with tetraplegia in real-life posthospitalization settings. It aims to evaluate its support in activities of daily living and conduct a preliminary health economic analysis comparing cost-effectiveness and QoL outcomes with standard care.

This mixed methods feasibility study will be conducted in posthospitalization settings in Switzerland. Up to 15 participants with upper limb impairments (SCI C0–Th1, AIS A–D) using powered wheelchairs will be recruited. They will use the robotic arm for 6 consecutive days. An equal number of participants will be recruited for the economic analysis group. Quantitative data will be collected at baseline and postintervention via standardized questionnaires (Post-Study System Usability Questionnaire, National Aeronautics and Space Administration Task Load Index, European Quality of Life 5-Dimension 5-Level questionnaire, Visual Analogue Scale, adapted version of the Canadian Occupational Performance Measure, and Client Socio-Demographic and Service Receipt Inventory-European Version), while qualitative feedback will be gathered through an informal questionnaire and semistructured interviews. Feasibility will be assessed through task performance and health economic analysis. The latter will include quality-adjusted life years, which quantify quality and length of life, and modeling the Incremental Cost-Effectiveness Ratio, which compares the cost-effectiveness of the intervention based on cost per quality-adjusted life years gained. Findings will be integrated in line with the convergent parallel mixed methods design.

Recruitment began in April 2025 and is ongoing as planned; full feasibility, usability, and economic results will be reported upon study completion. We expect the robotic system to reduce caregiver time and associated costs, while enhancing autonomy, QoL, and mental well-being. Potential technical and recruitment challenges have been identified and mitigation strategies planned. Evaluating real-life use of a WMRAs, this study could support the wider adoption of assistive robotic technologies.

This research offers key insights into the feasibility, usability, and economic value of robotic assistance for individuals with tetraplegia and will help inform future development and scale-up studies.