## 4 Discussion
### Effectiveness  
In dose-matched trials, there is no evidence that the type of UE-RT is an important factor in the outcome. In the present study, both the control and intervention groups were dose-matched and both of them improved their UE function across the treatment proposed in this methodology. However, this condition, in conjunction with the inclusion of the drinking ADL within the UE-RT sessions, allowed us to detect some differences in the intervention group. Although both experimental groups improved their level of independence in ADL assessed by means of the SCIM scale, only the intervention group improved their level of independence with statistical significance and clinical relevance in the item related to eating. This may be due to the fact that, within the UE-RT sessions, they worked on the ADL-related gesture of drinking from a glass. In the JTHF scale, in the intervention group, there was an increase of 26.66% in the subjects who were able to perform the test in the assessment upon ending the treatment compared to the baseline assessment, while in the control group, this increase was of 18.75%. In relation to the kinematic indices, both experimental groups significantly improved their movement smoothness measured from the peaks number in the hand velocity profile, although the difference between the assessments at the ending and baseline was significantly greater in the intervention group (24.14 (18.48)) than in the control (10.75 (17.17)), probably because the subjects in the intervention group worked with the Armeo Spring on the ADL movement pattern with the appropriate intensity and number of repetitions. In the comparison between groups, it is worth highlighting the result obtained when the analysis was specified to cases in which the treated UE was the dominant one. In this case, no statistical significance was obtained between the groups. However, in the intervention group, an increase in the amplitude of the box plot was observed and the case of the subject who experienced the greatest improvement in smoothness of movement did not appear as an outlier or atypical result within the sample analyzed, thus reflecting the importance of taking dominance into account in these studies. On the other hand, although the improvement observed in the coordination index was not statistically significant, it was considered clinically relevant in the intervention group due to the calculated effect size. In view of the results, it appears that UE-RT and the virtual reality application for the drinking task have a positive influence on the movement pattern of the UE during the performance of the ADL of drinking in a real environment,as determined through the intensity, number of repetitions, motivation, sources of feedback provided by robotic therapy, and the novel virtual environment used by the Armeo Spring device. The inclusion of the kinematic indices as an assessment method is a strength of the present study and complements a previous study published by us with a minor sample size [44]. In this previous study, all the participants were evaluated only by means of the Capabilities of Upper Extremity (CUE) Questionnaire and the SCIM scale with the aim of analyzing the impact of robotic therapy in the self-perception of limited UE function that SCI patients have and analyzing the correlation between both clinical scales. This correlation was higher at the ending of the study than at baseline for both groups, obtaining a correspondence between patients' self-perception and their functional independence. In addition, the present study was complemented with anxiety and depression evaluations, obtaining that the results in the present study were not influenced by the emotional state of the subjects participating in this study, since findings of anxiety and depression were not detected by the BDI and HAD scales.