## 4 Discussion  
In recent years, there has been a significant increase in the number of available robotic systems for rehabilitation of the upper limb. Until 2014, 120 upper limb robotic systems were identified in a review [20]. However, while numerous studies on the efficacy of these systems are available [6], there is a lack of scientific data on the usability [21], efficiency, and applicability in clinical practice [22; 23]. Indeed, even when an intervention has good evidence of benefits, the application of evidence-based practice for stroke can still raise challenges [24]. This problem is of particular importance when dealing with rehabilitation treatments based on technology and robotics. Therefore, clinicians specialized in the rehabilitation field should have tools to identify the appropriate type of technological system, according to the specific rehabilitation aims. To the best of our knowledge, a standardized and detailed model to evaluate and compare these technological devices is not described in the scientific literature. Therefore, moving from the above-mentioned considerations, in this paper we suggest a methodological approach to choose a set of devices, both electromechanical and robotic, based on the rehabilitation aims, followed by a pilot study to evaluate the feasibility of the identified set of devices in clinical practice. A multidisciplinary team from our institution discussed the clinical needs of upper limb rehabilitation; namely, the need to perform an intensive and a comprehensive treatment of the arm (including shoulder, elbow, wrist, and hand). Then, it analyzed some robotic solutions available commercially, in order to generate a prioritized list of devices of potential interest to be acquired by our institution (considering the rehabilitation aims discussed herein). A specific form was created to standardize the description of the robotic devices, and therefore, to allow an easier comparison between them. The analyzed features included general information, the system characteristics, the accessibility for wheelchair users, safety issues, literature data, costs of purchase and maintenance, an indication of purchasing priority by physicians and/or physiotherapists, and efficiency parameters. Ultimately, four devices were selected for intensive and comprehensive upper limb rehabilitation. Our main goal was to implement, in a sustainable way, the robotic rehabilitation in our rehabilitation department, and therefore, we gave priority to the efficiency level (weight = 4). In this way, we were able to select a set of robots that: had a reduced set-up time, were accessible for wheelchair users, were easy to be autonomously used by the patient, were suitable for group therapy, and required a low number of physiotherapists to be involved in the treatment (i.e., more than one patient can be treated with the supervision of one physical therapist). Moreover, we had privileged robots able to provide outcome measures, in order to easily quantify the rehabilitation path of the patient and to modify it, accordingly. Finally, we selected a set of devices able to treat patients with different levels of upper limb impairment, from severe to mild. In the second phase, to support our institution in planning the most convenient investment strategy aimed to improve the clinical quality and management efficiency in seven of the 29 centers of our institution, a feasibility pilot study was performed. The purpose of this pilot clinical study was to verify the usability and applicability of these systems, according to organizational model of our institution, and to investigate the effects of the robotic rehabilitation (using, precisely, a set of different devices), before extending the set in other centers of our Institution. The pilot study compared patients recruited in two FDG centers (one equipped with the set of devices and the other not equipped with it) and showed interesting results.