Technology Enabled Dose Optimization in Stroke Rehabilitation: A Systematic Evidence Synthesis of Intensity, Timing, and Functional Recovery

Abstract— Technology-assisted rehabilitation is increasingly used to deliver, monitor, and
individualize physiotherapy after stroke, yet the optimal therapeutic dose and the conditions under
which additional rehabilitation produces meaningful functional benefit remain uncertain. This
systematic evidence synthesis examined the relationship between rehabilitation dose, intensity, timing,
and functional recovery, with particular attention to technology-mediated approaches including robotic
training, telerehabilitation, neuroanimation, and electromechanical-assisted gait training. A structured
multi-source search identified approximately 4,200 unique records; 199 sources were fully extracted
and 30 studies were selected for detailed synthesis. The focused dataset included randomized trials,
observational cohorts, systematic reviews/meta-analyses, a guideline, a prognostic study, a trial
protocol, and a methodology paper. Because the primary studies differed substantially in populations,
dose metrics, and outcomes, narrative synthesis was combined with an exploratory random-effects
analysis of eight standardized mean differences reported across five meta-analyses. The pooled effect
was SMD 0.285 (95% CI 0.183–0.386; p<0.0001), with moderate heterogeneity (I²=49.4%). The
evidence supports a non-linear, threshold-and-plateau dose–response pattern. Technology-mediated
interventions did not consistently outperform conventional rehabilitation when therapeutic dose was
matched; however, robotic/electromechanical gait training and structured telerehabilitation provide
scalable mechanisms for delivering higher or more measurable doses in selected populations. Timing
was a critical moderator, with excessive very-early mobilization associated with poorer outcomes,
while appropriately timed intensive therapy produced meaningful gains in subacute and chronic
phases. These findings support response-adaptive rehabilitation systems that combine dose monitoring,
patient stratification, and technology-assisted delivery rather than assuming that greater intensity alone
is universally beneficial.