Usability and Acceptance of a Social Robot in People with Multiple Sclerosis: A Comparative Cross-Sectional Study

Socially Assistive Robotics is an emerging interdisciplinary field that integrates robotics, medicine, cognitive and social sciences, and neuroscience to support people across diverse contexts. Despite recent advances, its potential for people with Multiple Sclerosis (MS) remains largely unexplored, even though MS affects sensory-motor, cognitive, and psychological domains where SAR interventions could offer substantial benefits.

This study aimed to evaluate the usability of a humanoid robot in people with MS (PwMS), compare their experiences with age-matched healthy subjects (HS) and exploratorily identify potential predictors of usability. Additionally, automated analysis of written language was explored as a supplementary approach to complement the quantitative measures.

This cross-sectional study was conducted in November 2025 at the laboratory of the Italian MS Foundation (Genoa, Italy). 20 PwMS (M age 51.4, SD 11.0 years; 65% female; M educational level 13.0, SD 3.4 years) and 20 age-matched HS (M age 47.3, SD 10.1 years; 60% female; M educational level 14.8, SD 2.2 years) completed four predefined tasks with the robot Pepper. Usability was assessed using the System Usability Scale (SUS). Attitudes toward robots, robot-related factors, and task-related effort were measured with the General Attitudes Toward Robots Scale (GAToRS), Godspeed questionnaire, and NASA-TLX, respectively. Psychological variables (e.g., personality traits from I-TIPI) and clinical characteristics for PwMS (e.g., cognitive functions via the app DIGICOG-MS, upper-limb difficulties with the AMSQ) were also collected. Written responses to open-ended questions were analyzed using Natural Language Processing (NLP).

SUS scores exceeded the standard cut-off in both groups, with no between-group differences (PwMS: M 81.0, HS: M 77.8; P=.392, r=0.14, 95% CI [0.01, 0.42]), indicating high usability. PwMS reported greater negative attitudes toward societal-level robot introduction (GAToRS S-: P=.024, r=0.36, 95%CI [0.08, 0.63]), and judged Pepper as more anthropomorphic (ANTR; P=.007, r=0.42, 95%CI [0.15, 0.67]) and intelligent (INT; P=.020, r=0.37, 95%CI [0.09, 0.61]) than HS. ANTR was strongly associated with visuospatial memory (DIGICOG-MS: ρ= -0.632, P=.003, 95%CI [-0.84, -0.26]), and relatively strong with both verbal memory (DIGICOG-MS: ρ= -0.504, P=.023, 95%CI [-0.77, -0.08]) and Agreeableness (I-TIPI: ρ= 0.491, P=.028, 95%CI [0.06, 0.77]). Exploratory forward stepwise regression showed that Conscientiousness (I-TIPI: B=2.064, 95%CI [0.679, 3.449]), negative personal attitudes toward robots (GAToRS P -: B =0.169, 95%CI [0.033, 0.306]), and perceived upper-limb difficulties (AMSQ: B=0.169, 95%CI [0.033, 0.306]) explained 64% of SUS variance (Adjusted R²= 0.568). Task-related frustration (NASA-TLX: B=- 1.497, 95%CI [-2.276, -0.719]) explained 48% of SUS variance (Adjusted R²= 0.451). NLP analyses revealed no between-group differences in lexical productivity or sentiment-lexicon coverage.

This study provides the first preliminary evidence that a social robot can be perceived as highly usable by PwMS, with usability ratings comparable to those of HS, suggesting that MS-related challenges may not hinder human-robot interaction. Psychological factors, prior attitudes toward robots, and clinical characteristics were associated with user experience in the MS group. Future research should explore whether integrating these measures alongside language-based approaches may inform the development of tailored interventions in MS.