Abstract: Current development of lower-limb rehabilitation exoskeleton robots has so far emphasized engineering performance optimization in the laboratory, while technical solutions remain disconnected from real clinical needs; needs-oriented design research grounded in frontline clinical scenarios remains scarce. This study adopted an exploratory cross-sectional design and recruited 63 frontline rehabilitation practitioners with clinical experience in exoskeleton operation from tertiary general hospitals and specialized rehabilitation hospitals in Hangzhou, Zhejiang. Combining quantitative questionnaires with semi-structured qualitative interviews, it systematically examined five dimensions: current device application, clinical pain points, functional upgrade needs, operation and maintenance and procurement preferences, and barriers to industrial promotion. The results revealed three core application shortcomings—time-consuming donning and adjustment (77.8%), excessive device weight (42.9%), and poor matching between preset gait patterns and natural human movement (42.9%); the most urgent functional upgrades were real-time dynamic biomechanical feedback (81.0%), interoperability with hospital information systems (HIS) (58.7%), and multimodal intelligent interaction (54.0%); and the major obstacles to scaled deployment were limited medical insurance reimbursement coverage (87.3%) and insufficient high-quality clinical evidence (57.1%). Accordingly, countermeasures were proposed in four dimensions—technological solutions for core pain points, scenario-based modular design, industrial translation pathways, and full-lifecycle proactive operation and maintenance—and a three-in-one framework for development and translation was established, namely "a universal hardware platform, scenario-specific functional modules, and full-lifecycle digital-intelligent services". The findings can provide data support and decision-making references for optimizing clinical adaptability and promoting the industrial translation of domestically manufactured lower-limb rehabilitation exoskeletons robots.