Patient and clinician perceptions, expectations, and usability of ankle exoskeletons for daily living: a...

Ankle exoskeletons offer promising support for individuals with chronic foot drop, yet user and clinician perspectives on their use in daily living remain underexplored. Related studies on lower limb exoskeletons have typically assessed user perceptions following direct physical interaction with devices, which may influence feedback and its interpretation. In contrast, this study aimed to assess perceptions, expectations, and usability through a convergent mixed-methods approach involving 43 participants (i.e., 27 patients diagnosed with foot drop and 16 clinicians), without requiring hands-on experience. Participants completed a pre-exposure Knowledge, Attitudes, and Practices (KAP) survey, viewed educational videos on ankle exoskeleton technology, and subsequently completed a follow-up survey assessing expectations, potential daily applications, and usability using the System Usability Scale (SUS). Quantitative analysis revealed that 70.4% of patients were initially unaware of exoskeletons, and 81.5% reported no understanding of how they function. Clinicians demonstrated significantly higher knowledge scores than patients ( $U=60$ , $p<0.001$ , $r=0.62$ ), while no statistically significant difference was found in attitude-related measures between groups ( $U=264$ , $p=0.18$ , $r=0.20$ ). Both groups reported generally positive perceptions of exoskeletons for improving mobility and independence. However, concerns regarding comfort, aesthetics, potential skin irritation, and integration into daily activities were identified as relevant barriers. Additionally, practical challenges such as cost, device bulkiness, and usability were noted by both groups. Qualitative findings complemented these results by providing further insight into user concerns and design expectations. These findings highlight key factors influencing the potential adoption of ankle exoskeletons and underscore the importance of user-centred design, extended trial opportunities, and adaptable, practical solutions for both clinical and home-based applications.