## 4 Discussion
### Limitations  
This narrative review of systematic reviews employs a structured methodology designed for the narrative reviews. However, several limitations must be acknowledged, which in turn provide valuable insights into future research directions. One significant limitation is the exclusion of conference proceedings, preprints, and gray literature. While this approach ensures that only rigorously peer-reviewed studiesare included, it may omit emerging trends, innovative pilot studies, and cutting-edge experimental work that has not yet undergone formal publication. Future research should consider integrating these sources to provide a more dynamic and up-to-date understanding of SASR developments, particularly in rapidly evolving fields such as AI-driven human-robot interaction and adaptive learning algorithms. Additionally, by focusing on the internationally published literature in English, this review enhances broad applicability and comparability across different healthcare settings. However, this language restriction may inadvertently exclude region-specific insights, localized best practices, and culturally adapted interventions that could significantly influence the effectiveness of SASRs. Future studies should prioritize multilingual and cross-cultural analyses, incorporating research from non-English sources to gain a more comprehensive view of SASR adoption and customization in diverse healthcare environments. Another limitation lies in the reliance on systematic reviews as the primary unit of analysis. While this approach ensures a synthesis of high-level evidence, it may overlook novel perspectives, individual case studies, and experimental research that provide deeper, context-specific insights. Future research should complement systematic reviews with primary studies, especially qualitative and mixed-methods research, to capture patient experiences, caregiver perspectives, and real-world implementation challenges. While the reviewed studies employ diverse methodologies, sample populations, and evaluation metrics, this variability reflects the multidimensional nature of SASRs and their applications across different contexts. Rather than being a limitation, this diversity underscores the need for more standardized frameworks and benchmarking tools that can facilitate clearer comparisons and assessments of SASR effectiveness, usability, and ethical considerations across diverse clinical settings. Developing common evaluation criteria could enhance the robustness of future research and support the integration of SASRs in various healthcare environments. Additionally, while this review primarily focuses on the healthcare applications of SASRs, their broader societal and psychological implications remain an important avenue for further exploration. Future research could deepen the understanding of SASR integration in caregiving settings by examining their long-term influence on caregiver dynamics, human-machine trust relationships, and ethical considerations, particularly as robotic autonomy continues to advance. To address these gaps, future research should carry out the following:  
Expand Data Sources: Incorporate conference proceedings, preprints, and gray literature to capture emerging trends and novel SASR applications. Enhance Cross-Cultural Insights: Conduct comparative studies across different linguistic and cultural contexts to understand the region-specific adaptations of SASRs. Integrate Primary Research: Combine systematic reviews with qualitative and mixed-methods studies to capture user experiences and implementation barriers. Develop Standardized Evaluation Frameworks: Establish universal benchmarking criteria for assessing SASR effectiveness, usability, and ethical compliance. Explore Long-Term Social and Psychological Effects: Investigate the evolving role of SASRs in human-machine relationships, trust formation, and ethical concerns in caregiving contexts.