• i. What specific types of robotic hand glove technologies have been designed, developed, or clinically implemented for stroke rehabilitation in Malaysia?

• ii. What clinical, functional, and safety outcomes have been reported in literature involving the use of robotic hand gloves among stroke patients within the Malaysian context?

• i. Stage 1: Identifying research questions. To establish a robust foundation for this study, a preliminary literature search was conducted. This initial step served to map out the overall scope of the topic dedicated to Malaysian context, ensure that no identical reviews were currently underway and confirm the availability of a sufficient volume of primary literature to warrant a scoping review.

• ii. Stage 2: Identifying relevant studies and defining eligibility criteria. All relevant studies will be identified across major academic databases. To ensure transparency and precision, explicit inclusion and exclusion criteria will be established prior to the search, focusing strictly on studies involving robotic hand gloves for stroke rehabilitation within the Malaysian context.

• iii. Stage 3: Study selection. The selection process will follow a rigorous, multi-stage screening framework. Titles and abstracts will first be assessed against the predefined eligibility criteria, followed by a detailed evaluation of full-text articles. This process will be documented systematically to account for all included and excluded literature.

• iv. Stage 4: Data extraction and charting. Data from the final pool of included studies will be extracted and organized using a standardized charting template. This extraction tool will capture key study characteristics, including technological specifications of the robotic gloves, clinical characteristics, intervention parameters, and measured clinical outcomes, ensuring a consistent and reproducible approach.

• v. Stage 5: Data collating, summarizing, and reporting. The extracted data will be synthesized to provide a comprehensive landscape of robotic glove utilization in Malaysia. Quantitative and descriptive findings such as geographical distribution of research, types of technology used and clinical metrics will be mapped visually using tables, charts, or diagrams. Qualitative insights regarding implementation barriers, costs and patient default rates will be analysed using thematic analysis to identify critical gaps in the current Malaysian stroke care framework.

Types of participants

This review will include studies that involve adult stroke patients aged 18 years and older. No restrictions will be placed on the specific type of stroke (ischemic or haemorrhagic), the clinical stage of recovery (acute, subacute, or chronic), gender, or ethnicity. To be eligible, participants must undergo a rehabilitation intervention that explicitly utilizes a wearable robotic hand glove or closely related robotic hand device.

Concept

This scoping review protocol will focus on the identification and mapping of wearable robotic hand glove technologies designed, developed, or implemented for stroke rehabilitation. Beyond physical motor recovery, this review will also explore the broader, secondary impacts of these devices on the rehabilitation process. Investigating these multi-dimensional effects is essential because robotic interventions influence more than just musculoskeletal recovery. Therefore, eligible studies must also report on one or more secondary outcomes, such as psychological well-being and patient motivation, cognitive engagement through interactive software or virtual reality (VR) integrations, functional independence in ADLs and finally the cost-effectiveness and feasibility of home-based rehabilitation within local communities.

Context

The context of this scoping review protocol is strictly defined by stroke neurorehabilitation research and clinical environments within Malaysia, including the clinical, academic and community settings. To ensure a thorough mapping of the local literature, eligible studies must be conducted within Malaysia healthcare facilities or local research institution. Accordingly, the search strategy will utilize tailored combinations of core regional and clinical terms, including “hand,” “glove,” “wearable device,” “stroke,” “cerebrovascular disease,” “neurorehabilitation,” and “rehabilitation device.”

Restricting the geographical and institutional scope to Malaysia is necessary because local neurorehabilitation pathways operate under infrastructure and financial constraints distinct from those in high-income nations. In Malaysia, post-stroke care is frequently challenged by a shortage of specialized neurorehabilitation professionals, uncoordinated transitions to community-based care, and high patient default rates after hospital discharge due to travel distances and geographical barriers.¹⁷ Furthermore, existing clinical services remain highly centralized within major urban centres, disadvantaging rural populations. Mapping and analysing technologies developed or tested specifically within this framework allows for a realistic assessment of how robotic gloves can be practically integrated into existing Malaysian clinical workflows and socioeconomic realities. Accordingly, eligible studies must be conducted by Malaysian institutions or evaluated directly within the Malaysian healthcare system.

Types of study

The scoping review will examine published primary articles reviews, and grey literature sources, including Malaysian government websites, university repositories, hospital or rehabilitation institution records involving stroke patients receiving robotic hand rehabilitation. While global research on robotic hand rehabilitation is extensive, applying international technology to a local healthcare system involves unique economic, regulatory, and population-specific challenges. To provide a highly relevant resource tailored to a developing healthcare environment, this review limits its geographic scope to studies conducted in Malaysia. This localized approach allows for an accurate mapping of domestic technological readiness, local barriers to clinical use, and engineering designs specifically suited for Malaysian users. As a result, studies focusing on the robotic rehabilitation of shoulders, lower limbs and feet are outside the scope of hand recovery and will be excluded from this review.

Sources

This scoping review will include the complete trajectory of robotic hand devices in Malaysia, spanning from early academic engineering prototypes to recent clinical implementations. Hence, this review will apply no date restrictions to its search strategy. Limiting the timeline would risk omitting formative domestic baseline data, as the development and deployment of hand robotics remains a relatively recent phenomenon within the Malaysian healthcare ecosystem. Furthermore, to accommodate local and international contributions, the review will consider eligible studies published in both English and Malay language. A comprehensive range of literature will be considered to ensure a thorough mapping of the local research landscape, including primary literature (quantitative, qualitative, or mixed-method designs, regardless of methodological approach), secondary literature (evidence syntheses, including systematic reviews, scoping reviews, meta-analyses, clinical practice guidelines, and policy papers), and grey literature. Grey literature was adopted because given the specific geographical focus on Malaysia, grey literature will be actively targeted to minimize publication bias and capture local innovations that may not be indexed in mainstream commercial journals. This will include conference proceedings, government health reports, institutional white papers, unpublished research reports, and local university repositories for postgraduate medical and engineering theses. Books and book chapters will be excluded from this review due to structural limitations in accessing their full content consistently. Additionally, personal blogs, opinion pieces, and non-scholarly digital media will be omitted because they lack standardized, rigorous peer-review frameworks.

To ensure thorough coverage of the local landscape, a three-step search strategy will be employed across major international and regional electronic databases, including Scopus, Web of Science, and IEEE Xplore. This database cluster will be supplemented by targeted manual searches within specialized Malaysian academic databases to retrieve localized institutional outputs. The inclusion and exclusion criteria for articles screening can be found in Table 1.

The systematic search will follow the three-phase search strategy recommended by the JBI guidelines for scoping reviews.¹⁴ This approach ensures an exhaustive and transparent retrieval of both published and unpublished literature relevant to Malaysia context. Phase one, where we identify the keyword and piloting phase. An initial keyword analysis was conducted by examining the titles, abstracts, and index terms of foundational literature in the field. Preliminary search strings were piloted and iteratively refined across the Scopus, Web of Science, and IEEE Xplore databases using various Boolean logic combinations to optimize search sensitivity and specificity. Based on these exploratory trials, the baseline search string is structured as follows: (“robotic glove” OR “robotic hand” OR “robotic device” OR “wearable hand” OR “wearable glove” OR “exoskeleton robot”) AND (“stroke” OR “cerebrovascular accident” OR “post-stroke”) AND (“rehabilitation” OR “neurorehabilitation” OR “physical therapy” OR “occupational therapy” or “therapy”) AND (“Malaysia” OR “Malaysian”). Initial search that has been conducted in the selected databases and search engine can be found in Table 2.

Phase two of search strategy is by comprehensively searching across all selected databases and grey literature. The finalized search string will be systematically executed across all selected electronic databases. To ensure local research outputs, engineering prototypes, and clinical trials within the Malaysian context are captured, the search will extend to specialized grey literature platforms. This involves screening institutional university repositories for postgraduate medical and engineering theses, utilizing customized Google search engines, and searching the Grey Literature Report database. Furthermore, content experts and local researchers in the field of neurorehabilitation will be consulted to identify any missing, ongoing, or unpublished studies.

The third phase is screening the references. To maximize coverage, the reference lists of all final included primary articles and related systematic reviews will be manually screened. This backward citation tracking helps identify any additional studies that may have been missed during the electronic database search. A comprehensive log of the piloted search strategy across selected databases is detailed in Appendix I.

Following search in selected databases, all identified citations will be compiled in a Google spreadsheet for centralized data management. Duplicate records will be identified and removed. To ensure screening accuracy and establish high inter-rater reliability among the research team, a pilot test of the selection criteria will be conducted on a random sample of abstracts prior to the formal screening process. The primary screening of titles and abstracts will be performed independently by FN, with collaborative cross-checking assistance provided by WMAWAR and AHI based on the predefined eligibility criteria. Potentially eligible articles will undergo a detailed full-text review by the same team to confirm final inclusion. Any discrepancies or disagreements during either stage of the screening process will be discussed and resolved through consensus, or through consultation with ZIM or MHH. Methodology and validation will be reviewed by SAAH.

Records that do not fulfil the inclusion criteria at any stage will be excluded from the review. For articles evaluated and omitted during the full-text screening phase, the specific justifications for exclusion will be meticulously documented and reported. The complete screening, selection, and exclusion pathway will be visually summarized and presented in the final publication using a PRISMA-ScR flow diagram, as referenced in Figure 1.

Data from the final pool of included records will be extracted using a structured data extraction form developed specifically for this review ( Table 3 and Table 4). This charting tool is designed in accordance with the JBI scoping review methodology to ensure a comprehensive, systematic, and reproducible approach to data collection. Using a standardized framework will allow for the consistent identification and categorization of relevant technological and clinical information across all included studies.

The primary categories of data to be extracted from each study will include:

The baseline draft of the data extraction form is provided in Table 3 and Table 4. To ensure the tool captures all relevant nuances of the local literature, it will be refined iteratively by the research team during the active extraction phase. Any subsequent modifications or expansions made to this form to accommodate unexpected data fields will be fully documented and detailed in the final scoping review publication.

The extracted data will be systematically organized and presented in both tabular and narrative form to provide a clear overview of the findings.¹³ Tabular displays will be utilized to provide a clear, structured overview of the quantitative findings across all included literature. Descriptive statistics, including frequencies and percentages where applicable, will be used to summarize key baseline characteristics of the domestic research landscape. These visual matrices will specifically map out, including the geographical distribution of research and clinical trials across different states and institutions in Malaysia, specific types of robotic glove technologies implemented (e.g., soft pneumatic systems versus rigid exoskeletons), targeted neurophysiological and muscle groups (e.g., thenar and hypothenar coordination), and range of standardized clinical, functional, or usability outcomes reported.

A comprehensive narrative synthesis will accompany the tabular data to contextualize the quantitative metrics and provide deeper insights into the current state of the field. This narrative will discuss emerging technological themes, highlight variations in engineering and actuation designs, and critique current implementation practices within the constraints of the Malaysian healthcare framework. Furthermore, the synthesis will map out the relationship between specific device configurations and their practical utility, specifically focusing on documented barriers and facilitators to technology adoption, such as equipment affordability, clinical training demands, and patient compliance rates. Together, these complementary presentation methods aim to deliver a nuanced understanding of the current scope, developmental readiness, and systemic landscape of robotic hand rehabilitation devices for stroke survivors in Malaysia.