Social Processes: What Determines Industrial Workers' Intention to Use Exoskeletons?

The impact of an active and passive industrial back exoskeleton on functional performance

Due to differences in actuation and design, active and passive industrial back exoskeletons could influence functional performance, i.e., work performance, perceived task difficulty, and discomfort, differently. Therefore, this study investigated and compared the impact of the active CrayX (7 kg) and passive Paexo Back (4.5 kg) on functional performance. Eighteen participants performed twelve work-related tasks with both types of exoskeletons and without (NoExo). The CrayX hindered work performance up to 22% in multiple tasks, compared to the Paexo Back and NoExo, while work performance between NoExo and the Paexo Back condition was more comparable, except for stair climbing (13% hindrance). Perceived task difficulty and discomfort seldomly varied between both exoskeletons. Although the CrayX shows promise to benefit workers, limitations in hindrance and comfort should first be addressed. The Paexo Back has demonstrated an advantage in certain static tasks. However, increasing its potential across a broader range of tasks seems warranted.Practitioner Summary: Differences between industrial back exoskeletons with regard to functional performance, i.e. work performance, discomfort and perceived task difficulty, were investigated by evaluating the active CrayX and passive Paexo Back back exoskeletons. The CrayX significantly hindered functional performance, while the Paexo Back seldomly affected functional performance.Abbreviations: WMSD: Work-related musculoskeletal disorder; NoExo: No Exoskeleton; GD: General discomfort; PTD: Perceived task difficulty; BMI: Body Mass Index.

Age and gender differences in the perception and use of soft vs. rigid exoskeletons for manual material handling

We investigated age and gender differences in the perception and use of soft (Apex) vs. rigid (Paexo Back) passive back-support exoskeletons (BSE) for repetitive lifting and lowering. A gender-balanced sample of 20 young (18-30 years) and 16 old (45-60 years) individuals were recruited. In the first session, participants' self-reported maximum acceptable load (MAL) was assessed using a psychophysical approach. Changes in muscle activity and kinematics due to BSE use in repetitive lifting/lowering tasks were also assessed. Overall, both BSEs increased MAL (by ∼7%), and reduced trunk extensor muscle activity across all groups (by ∼7-18%), compared to the control condition. Both BSEs promoted more squatting postures, increased quadriceps muscle activity (by ∼34%) and abdominal muscle activity during asymmetric tasks (by 5-20%). Some age and gender differences were significant, particularly for the trunk kinematics when using the Apex. Future work should include more diverse user groups in studying willingness to adopt BSEs and characterising their consequent effects on the body.

Perceived benefits, barriers, perceptions, and readiness to use exoskeletons in the construction industry: Differences by demographic characteristics

Exoskeletons (EXOs) are a promising wearable intervention to reduce work-related musculoskeletal disorder risks among construction workers. However, the adoption of EXOs may differ with demographic characteristics. Survey data (n = 361) were collected from construction industry stakeholders and a summation score method was used to summarize respondent's benefits and barriers to EXO use, along with perceptions and readiness to use. Responses were stratified by race (White vs. non-White), sex (male vs. female), and age (<47 years vs. ≥47 years). Both a higher Benefits score and a higher Perceptions score were significantly and positively associated with a higher Readiness to Use score. There were also significant differences in perceived barriers to EXO use by race and sex. These results demonstrate substantial interest in EXO use but also emphasize the need to ensure proportionate access to the potential benefits of EXO technology.

Exoskeleton technology in nursing practice: assessing effectiveness, usability, and impact on nurses' quality of work life, a narrative review

The use of exoskeletons in nursing practice has gained attention as a potential solution to address the physical demands and risks associated with the profession. This narrative review examines the effectiveness, usability, and impact of exoskeleton technology on nurses' quality of work life. The review focuses on the reduction of physical strain and fatigue, improved posture and body mechanics, enhanced patient care, usability and acceptance factors, and the broader impact on work life. The effectiveness of exoskeletons in reducing physical strain and fatigue among nurses is supported by evidence showing decreased muscle activation and reduced forces exerted on the body. The usability and acceptance of exoskeletons are critical considerations, including device comfort and fit, ease of use and integration into workflows, user experience and training, compatibility with the work environment, and user feedback for iterative design improvements. The implementation of exoskeletons has the potential to positively impact nurses' work life by reducing work-related injuries, improving physical well-being, enhancing job satisfaction, and promoting psychological and psychosocial benefits. Additionally, the use of exoskeletons can lead to improved patient care outcomes. Challenges and future directions in the field of exoskeleton technology for nurses include cost and accessibility, adaptability to nursing specialties and tasks, long-term durability and maintenance, integration with personal protective equipment, and ethical considerations. Addressing these challenges and considering future research and development efforts are crucial for the successful integration of exoskeleton technology in nursing practice, ultimately improving nurses' quality of work life and patient care delivery.

Understanding contributing factors to exoskeleton use-intention in construction: a decision tree approach using results from an online survey

Work-related musculoskeletal disorders (WMSDs) are a major health concern in the construction industry. Occupational exoskeletons (EXOs) are a promising ergonomic intervention to help reduce WMSD risk. Their adoption, however, has been low in construction. To understand the contributing factors to EXO use-intention and assist in future decision-making, we built decision trees to predict responses to each of three EXO use-intention questions (Try, Voluntary Use, and Behavioural Intention), using online survey responses. Variable selection and hyperparameter tuning were used respectively to reduce the number of potential predictors and improve prediction performance. The importance of variables in each final tree was calculated to understand which variables had a greater influence. The final trees had moderate prediction performance. The root node of each tree included EXOs becoming standard equipment, fatigue reduction, or performance increase. Important variables were found to be quite specific to different decision trees. Practical implications of the findings are discussed.Practitioner summary: This study used decision trees to identify key factors influencing the use-intention of occupational exoskeletons (EXOs) in construction, using online survey data. Key factors identified included EXOs becoming standard equipment, fatigue reduction, and performance improvement. Final trees provide intuitive visual representations of the decision-making process for workers to use EXOs.

Exploring technology acceptance of head-mounted device-based augmented reality surgical navigation in orthopaedic surgery

BACKGROUND

This study used the Unified Theory of Acceptance and Use of Technology (UTAUT) to investigate the acceptance of HMD-based AR surgical navigation.

METHODS

An experiment was conducted in which participants drilled 12 predefined holes using freehand drilling, proprioceptive control, and AR assistance. Technology acceptance was assessed through a survey and non-participant observations.

RESULTS

Participants' intention to use AR correlated (p < 0.05) with social influence (Spearman's rho (rs) = 0.599), perceived performance improvement (rs = 0.592) and attitude towards AR (rs = 0.542).

CONCLUSIONS

While most participants acknowledged the potential of AR, they also highlighted persistent barriers to adoption, such as issues related to user-friendliness, time efficiency and device discomfort. To overcome these challenges, future AR surgical navigation systems should focus on enhancing surgical performance while minimising disruptions to workflows and operating times. Engaging orthopaedic surgeons in the development process can facilitate the creation of tailored solutions and accelerate adoption.

The Dynamic Adoption Journey: A Typology for Users and Non-Users of Occupational Exoskeletons

Various barriers prevent the adoption of occupational exoskeletons. It is therefore important to understand why some people are willing to use occupational exoskeletons, while others are not. To identify why people use or do not use exoskeletons, we created a typology describing different types of users and non-users. These types were created based on existing literature on internet adoption and social robots. Next, literature and empirical data were used to identify reasons why some people use exoskeletons and others do not use them (yet). The typology includes users with pain and users without work-related musculoskeletal disorders, but also non-users: resisters, rejecters, discontinuers, excluded or expelled non-users. It can be used by companies interested in implementing exoskeletons to identify possible early adopters. For exoskeleton designers, it can be used as a tool to identify non-users and focus on design strategies to enable non-users to become users (such as making exoskeletons that would fit people with a wide range of body shapes). Future research can use these types to identify users and non-users in field trials or pilot projects.

Does a Soft Actuated Back Exosuit Influence Multimodal Physiological Measurements and User Perception During an Industry Inspired Task?

Back support soft exosuits are promising solutions to reduce risk of musculoskeletal injuries at workplaces resulting from physically demanding and repetitive lifting tasks. Design of novel active exosuits address the impact on the muscle activity and metabolic costs but do not consider other critical aspects such as comfort and user perception during the intended tasks. Thus, in this study, we describe a novel soft active exosuit in line with its impact on physiological and subjective measures during lifting. We tested four healthy participants who performed repetitive lifting tasks with and without this exosuit. The exosuit provided assistance proportional to the lumbar flexion angle measured using an inertial measurement unit. We measured the participant's multimodal physiological measures including surface electromyography, metabolic cost, heart rate, and skin temperature. We also measured subjective scores on user exertion, task load, and device acceptability. All participants perceived a reduction in task load when using the exosuit. Three participants showed reduction of muscle activity for the erector spinae muscles. The metabolic costs and heart rate reserve reduced for two participants, with similar trends for skin temperature. For future development of workplace exosuits, we recommend incorporating assessments of both physiological and subjective measures, considering the user-dependent response to the exosuit.

Side-effects and adverse events of a shoulder- and back-support exoskeleton in workers: A systematic review

INTRODUCTION

While the biomechanical effects of exoskeletons are well studied, research about potential side-effects and adverse events are limited. The aim of this systematic review was to provide an overview of the side-effects and adverse events on shoulder- and back-support exoskeletons during work tasks.

METHODS

Four in-field studies and 32 laboratory studies were included in this review, reporting on n = 18 shoulder exoskeletons, n = 9 back exoskeletons, n = 1 full body with a supernumerary arm, and n = 1 combination of shoulder and back exoskeleton.

RESULTS

The most frequent side-effect reported is discomfort (n = 30), followed by a limited usability of the exoskeleton (n = 16). Other identified side-effects and adverse events were changes in muscle activity, mobility, task performance, balance and posture, neurovascular supply, gait parameters and precision. An incorrect fit of the exoskeleton and the decreased degrees of freedom are most often reported as causes of these side-effects. Two studies did not find any side-effects. This review also showed that there are differences in the occurrence of side-effects in gender, age, and physical fitness. Most studies (89%) were conducted in a laboratory setting. Most studies (97%) measured short-term effects only. Psychological and social side-effects or adverse events were not reported. Side-effects and adverse events for active exoskeletons were understudied (n = 4).

CONCLUSION

It was concluded that the evidence for side-effects and adverse events is limited. If available, it mainly consists of reports of mild discomfort and limited usability. Generalisation is limited because studies were conducted in lab settings and measured short term only, and most participants were young male workers.

Getting Connected to M-Health Technologies through a Meta-Analysis

The demand for mobile e-health technologies (m-health) continues with constant growth, stimulating the technological advancement of such devices. However, the customer needs to perceive the utility of these devices to incorporate them into their daily lives. Hence, this study aims to identify users' perceptions regarding the acceptance of m-health technologies based on a synthesis of meta-analysis studies on the subject in the literature. Using the relations and constructs proposed in the UTAUT2 (Unified Theory of Acceptance and Use of Technology 2) technology acceptance model, the methodological approach utilized a meta-analysis to raise the effect of the main factors on the Behavioral Intention to Use m-health technologies. Furthermore, the model proposed also estimated the moderation effect of gender, age, and timeline variables on the UTAUT2 relations. In total, the meta-analysis utilized 84 different articles, which presented 376 estimations based on a sample of 31,609 respondents. The results indicate an overall compilation of the relations, as well as the primary factors and moderating variables that determine users' acceptance of the studied m-health systems.

Exploring the impact of motivations on individual online and offline preventive actions against COVID-19

Having accurate and sufficient information about the outbreak and actively adopting preventive actions are important to reduce the adverse effects of COVID-19 and control the spread of the epidemic. To this end, grounded in the situational theory of problem solving (STOPS) and self-concern and other-orientation theory, this study aims to examine motivations of individuals to adopt online and offline preventive actions during the COVID-19 pandemic. We explored the effects of three motivations, i.e., situational motivation, concern-for-self and concern-for-others motivation, and their antecedents on individual online and offline preventive actions. We used PLS-SEM to analyze the results of 628 questionnaires and found that: first, individual online preventive actions have a positive predictive effect on offline actions; secondly, individual online preventive actions are positively affected by situational motivation and concern-for-others motivation, and individual offline preventive actions are positively affected by concern-for-self and concern-for-others motivation; finally, three situational perceptual factors including problem, involvement and constraint recognition have significant effects on the three motivations. The findings of this study enriched the research results on individual behaviors in the context of COVID-19, and provided a basis for making decisions on the guidance and management of the individuals' COVID-19 preventive actions.

Supplementary Information

The online version contains supplementary material available at 10.1007/s12144-023-04283-z.

IMU-based human activity recognition and payload classification for low-back exoskeletons

Nowadays, work-related musculoskeletal disorders have a drastic impact on a large part of the world population. In particular, low-back pain counts as the leading cause of absence from work in the industrial sector. Robotic exoskeletons have great potential to improve industrial workers' health and life quality. Nonetheless, current solutions are often limited by sub-optimal control systems. Due to the dynamic environment in which they are used, failure to adapt to the wearer and the task may be limiting exoskeleton adoption in occupational scenarios. In this scope, we present a deep-learning-based approach exploiting inertial sensors to provide industrial exoskeletons with human activity recognition and adaptive payload compensation. Inertial measurement units are easily wearable or embeddable in any industrial exoskeleton. We exploited Long-Short Term Memory networks both to perform human activity recognition and to classify the weight of lifted objects up to 15 kg. We found a median F1 score of [Formula: see text] (activity recognition) and [Formula: see text] (payload estimation) with subject-specific models trained and tested on 12 (6M-6F) young healthy volunteers. We also succeeded in evaluating the applicability of this approach with an in-lab real-time test in a simulated target scenario. These high-level algorithms may be useful to fully exploit the potential of powered exoskeletons to achieve symbiotic human-robot interaction.

Passive shoulder exoskeleton support partially mitigates fatigue-induced effects in overhead work

BACKGROUND

Despite the potential of occupational passive shoulder exoskeletons (PSEs) to relieve overhead work, limited insights in overhead work precision performance impedes large-scale adoption in industry.

OBJECTIVE

To investigate the effect of PSE support on the reduction in task performance caused by physical fatigue.

METHODS

This experiment consisted of a randomized, counterbalanced cross-over design comparing Exo4Work PSE support and no support, in a physically fatigued state and a control condition. Precision performance was determined using execution speed and drilling errors. Muscle activity and shoulder joint kinematics were recorded.

RESULTS

Fatigue altered task performance, shoulder joint kinematics, muscle activity and subjective experience during overhead work. The PSE support mitigated the fatigue-induced changes in shoulder kinematics. Additionally, a part of the fatigue-induced co-activation of shoulder stabilizing muscles was avoided when working with the PSE. The PSE support also reduced the activity of the anterior and medial deltoid.

CONCLUSION

Physical fatigue provokes compensatory movements and increased co-contraction of muscles when executing overhead work. These fatigue-induced alterations are generally believed to increase the overall musculoskeletal load. The support provided by the PSE reduced muscle activity of muscles working to elevate the arm, but also partially mitigated those fatigue-induced effects.

SIGNIFICANCE

This study shows that the effect of PSE support on precision performance is limited, and suggested that, apart from the known effects of PSE support during overhead work, wearing the exoskeleton in a physically fatigued state may provide additional advantages.

Investigating the Overall Experience of Wearable Robots during Prototype-Stage Testing

Wearable robots (WRs) might interact with humans in a similar manner to teammates to accomplish specific tasks together. However, the available data on WR user experience (UX) studies are limited, especially during the prototyping phase. Therefore, this study aims to examine the overall experience of WRs during the prototyping phase based on an exploratory research model. This theoretical model considered usability, hedonic quality, and attitude toward using WRs as key factors in explaining and predicting overall experience. To test the hypotheses inherent in the research model, quantitative empirical research was conducted and the data were analyzed by partial least squares structural equation modeling (PLS-SEM). The results from the PLS-SEM analysis revealed the significance level of correlations between the latent variables in the research model. The exploratory research model was able to explain up to 53.2% of the variance in the overall experience of using WRs, indicating medium predictive power. This research develops a new quantitative empirical research model that can be used to explain and predict the overall experience of interactive products such as WRs. Meanwhile, the model is needed during WR testing in the prototype phase.

Exploratory Field Testing of Passive Exoskeletons in Several Manufacturing Environments: Perceived Usability and User Acceptance

OCCUPATIONAL APPLICATIONSResults of the current exploratory study suggest that use of an exoskeleton (EXO) has the potential to be accepted by workers as an intervention in diverse manufacturing environments. Also evident were that the major factors contributing to EXO-use-intention are perceived comfort, task-technology fit, perceived safety, and perceived usefulness. A user's perception of perceived usability may be established by using an exoskeleton during actual job tasks, yet some aspects of perceived usability likely require multiple exposures to an EXO for an accurate assessment. Many negative comments regarding EXO use were related to physical constraints (e.g., restricted movements, bulkiness), and to the EXO interface (e.g., straps, cuff designs), suggesting a need for further research on EXO design to minimize discomfort. In practice, there is likely value in having workers use and explore candidate EXOs during their actual job, both to accurately assess the usefulness of an EXO and to find the most effective EXO.

An industrial exoskeleton user acceptance framework based on a literature review of empirical studies

Studying the acceptance of exoskeletons in industry has gained increased attention. Exoskeletons (wearable support devices) are envisioned to alleviate heavy work. Examining what factors influence the use of exoskeletons is important, because influencing these factors could positively contribute to the adoption of industrial exoskeletons. The factors identified in this paper have been systematically derived from empirical research with (potential future) end users, most of whom have tried on an exoskeleton. Our framework with factors influencing the acceptance of industrial exoskeletons can be used during the (ideally iterative) design, (re)development and evaluation phase of new or existing exoskeletons. This could improve the quality of exoskeletons since this allows designers to already consider acceptance factors early in the design process instead of finding out what is important late in the design process during (field) testing. In turn, this might accelerate the adoption of exoskeletons. Also, our framework can be used to study the ongoing introduction of exoskeletons at work since it also addresses policy decisions companies interested in implementing exoskeletons should consider.

An Occupational Shoulder Exoskeleton Reduces Muscle Activity and Fatigue During Overhead Work

Objective. This paper assesses the effect of a passive shoulder exoskeleton prototype, Exo4Work, on muscle activity, muscle fatigue and subjective experience during simulated occupational overhead and non-overhead work. Methods. Twenty-two healthy males performed six simulated industrial tasks with and without Exo4Work exoskeleton in a randomized counterbalanced cross-over design. During these tasks electromyography, heart rate, metabolic cost, subjective parameters and performance parameters were acquired. The effect of the exoskeleton and the body side on these parameters was investigated. Results. Anterior deltoid activity and fatigue reduced up to 16% and 41%, respectively, during isometric overhead work, and minimized hindrance of the device during non-overhead tasks. Wearing the exoskeleton increased feelings of frustration and increased discomfort in the areas where the exoskeleton and the body interfaced. The assistive effect of the exoskeleton was less prominent during dynamic tasks. Conclusion. This exoskeleton may reduce muscle activity and delay development of muscle fatigue in an overhead working scenario. For dynamic applications, the exoskeleton's assistive profile, which mimics the gravitational torque of the arm, is potentially sub-optimal. Significance. This evaluation paper is the first to report reduced muscle fatigue and activity when working with an occupational shoulder exoskeleton providing one third of the gravitational torque of the arm during overhead work. These results stress the potential of occupational shoulder exoskeletons in overhead working situations and may direct towards longitudinal field experiments. Additionally, this experiment may stimulate future work to further investigate the effect of different assistive profiles.

Assoziation, Erwartungen und Barrieren eines Exoskeletteinsatzes in kleinen mittelständischen Unternehmen

Hintergrund

Arbeitsbedingte Muskel-Skelett-Erkrankungen (MSE) führen in der herstellenden Industrie zu Krankheitstagen und haben erhebliche wirtschaftliche Folgen für die Unternehmen und die Volkswirtschaft. Exoskelette können den Körper im Umgang mit schwerer Last oder in Zwangshaltungen unterstützen. Besonders in großen Unternehmen der Automobilindustrie werden Exoskelette pilotiert. In kleinen und mittelständischen Unternehmen (KMU) werden Exoskelette bisher jedoch wenig eingesetzt, und ihre Anwendung dort wurde wissenschaftlich bisher kaum untersucht. Ziel dieser Arbeit war es, die Barrieren der Exoskelett-Implementierung und die Erwartungen an deren Einsatz im produzierenden Gewerbe zu ermitteln.

Methode

In sechs produzierenden Unternehmen wurden teilstrukturierte Leitfadeninterviews durchgeführt und analysiert.

Ergebnisse

In den Unternehmen werden vielfältige Tätigkeiten bis an die Belastungsgrenze ausgeführt. Allgemein erwartet man durch die Anwendung von Exoskeletten Arbeitserleichterungen sowie wirtschaftliche Vorteile. Bedenken bestehen hinsichtlich des Einsatzes aufgrund des Kostenfaktors, eines ungewissen Nutzens und mangelnden Tragekomforts. Insbesondere werden mangelnde Kenntnisse über den Effekt eines Exoskeletts deutlich.

Fazit

Die vorgestellten Interviewergebnisse sind ein Schritt im interdisziplinären Prozess der Weiterentwicklung und Implementierung von Exoskeletten in der herstellenden Industrie. Bedenken und Unwissenheit potenzieller Unternehmen und Anwender müssen adressiert werden, auch um eine hohe Nutzerakzeptanz zu schaffen. Folgestudien, die die Ermittlung des Bedarfs mit einer besseren Trennschärfe erheben, könnten weitere Erkenntnisse liefern.

Usability, User Acceptance, and Health Outcomes of Arm-Support Exoskeleton Use in Automotive Assembly: An 18-month Field Study

OBJECTIVE

Examine arm-support exoskeleton (ASE) user experience over time, identify factors contributing to ASE intention-to-use, and explore whether ASE use may influence the number of medical visits.

METHODS

An 18-month, longitudinal study with ASE (n = 65) and control groups (n = 133) completed at nine automotive manufacturing facilities.

RESULTS

Responses to six usability questions were rather consistent over time. ASE use perceived effective in reducing physical demands on the shoulders, neck, and back. Perceived job performance, and overall fit and comfort, appeared to be key determinants for ASE intention-to-use. Based on medical visits among both groups, ASE use may decrease the likelihood of such visits.

CONCLUSIONS

These field results support the potential of ASEs as a beneficial ergonomic intervention, but also highlight needs for further research on ASE designs, factors driving intention-to-use, and health outcomes.

Deep learning for biosignal control: insights from basic to real-time methods with recommendations

Biosignal control is an interaction modality that allows users to interact with electronic devices by decoding the biological signals emanating from the movements or thoughts of the user. This manner of interaction with devices can enhance the sense of agency for users and enable persons suffering from a paralyzing condition to interact with everyday devices that would otherwise be challenging for them to use. It can also improve control of prosthetic devices and exoskeletons by making the interaction feel more natural and intuitive. However, with the current state of the art, several issues still need to be addressed to reliably decode user intent from biosignals and provide an improved user experience over other interaction modalities. One solution is to leverage advances in Deep Learning (DL) methods to provide more reliable decoding at the expense of added computational complexity. This scoping review introduces the basic concepts of DL and assists readers in deploying DL methods to a real-time control system that should operate under real-world conditions. The scope of this review covers any electronic device, but with an emphasis on robotic devices, as this is the most active area of research in biosignal control. We review the literature pertaining to the implementation and evaluation of control systems that incorporate DL to identify the main gaps and issues in the field, and formulate suggestions on how to mitigate them. Additionally, we formulate guidelines on the best approach to designing, implementing and evaluating research prototypes that use DL in their biosignal control systems.

Exoskeleton acceptance and its relationship to self-efficacy enhancement, perceived usefulness, and physical relief: A field study among logistics workers

Objective

This field study aimed to explore the effects of exoskeleton use on task-specific self-efficacy beliefs of logistics workers and to relate these effects to usefulness perceptions and technology acceptance.

Background

A growing number of industrial companies have shown interest in having employees wearing exoskeletons to support their physical health. However, psychological consequences of exoskeleton use and mechanisms associated with workers' acceptance or rejection of exoskeletons are not yet sufficiently understood.

Methods

A total of 31 logistics workers of a vehicle manufacturing company reported on their work-related self-efficacy, that is, how capable they felt of performing tasks related to their job well, before partaking in half-hour trials of a passive lift-assistive exoskeleton (Laevo V2.5) during their normal work. Afterward, they completed a questionnaire on their exoskeleton-supported self-efficacy and indicated how useful they found the exoskeleton, how much physical relief they felt from wearing it, and how willing they were to continue with its use.

Results

Overall, wearing the exoskeleton did not lead to increased work-specific self-efficacy. However, indications of interaction effects were found between baseline self-efficacy, perceived physical relief, and perceived usefulness in such a way that workers who experienced the exoskeleton as more strain-relieving or more useful were also more likely to report a post-trial growth in their self-efficacy beliefs. A positive change in self-efficacy, in turn, was associated with a greater willingness to further use the exoskeleton at the workplace.

Effects of industrial back-support exoskeletons on body loading and user experience: an updated systematic review

This study is an updated systematic review of papers published in the last 5 years on industrial back-support exoskeletons. The research questions were aimed at addressing the recent findings regarding objective (e.g. body loading, user performance) and subjective evaluations (e.g. user satisfaction), potential side effects, and methodological aspects of usability testing. Thirteen studies of active and twenty of passive exoskeletons were identified. The exoskeletons were tested during lifting and bending tasks, predominantly in laboratory settings and among healthy young men. In general, decreases in participants' back-muscle activity, peak L5/S1 moments and spinal compression forces were reported. User endurance during lifting and static bending improved, but performance declined during tasks that required increased agility. The overall user satisfaction was moderate. Some side effects were observed, including increased abdominal/lower-limb muscle activity and changes in joint angles. A need was identified for further field studies, involving industrial workers, and reflecting actual work situations. Practitioner summary: Due to increased research activity in the field, a systematic review was performed of recent studies on industrial back-support exoskeletons, addressing objective and subjective evaluations, side effects, and methodological aspects of usability testing. The results indicate the efficiency of exoskeletons in back-load reduction and a need for further studies in real work situations. Abbrevaitions: BB: biceps brachii; BF: biceps femoris; CoM: centre of mass; DA: deltoideus anterior; EMG: electromyography; ES: erector spinae; ES-C: erector spinae-cervical; ESI: erector spinae iliocostalis; ESI-L: erector spinae iliocostalis-lumborum; ESL: erector spinae longissimus; ES-L: erector spinae-lumbar; ESL-L: erector spinae longissimus-lumborum; ESL-T: erector spinae longissimus-thoracis; ES-T: erector spinae-thoracic; GM: glutaeus maximus; LBP: low back pain; LD: latissimus dorsi; LPD: local perceived discomfort scale; LPP: local perceived pressure scale; MS: multifidus spinae; MSD: musculoskeletal disorder; M-SFS: modified spinal function sort; NMV: no mean value provided; OA: obliquus abdominis (internus and externus); OEA: obliquus externus abdominis; OIA : obliquus internus abdominis; RA: rectus abdominis; RF: rectus femoris; RoM: range of motion; SUS: system usability scale; T: trapezius (pars Ascendens and Descendens); TA: trapezius pars ascendens; TC: mid-cervical trapezius; TD: trapezius pars descendens; VAS: visual analog scale; VL: vastus lateralis; VM: vastus medialis.

The Sensor-Based Biomechanical Risk Assessment at the Base of the Need for Revising of Standards for Human Ergonomics

Due to the epochal changes introduced by “Industry 4.0”, it is getting harder to apply the varying approaches for biomechanical risk assessment of manual handling tasks used to prevent work-related musculoskeletal disorders (WMDs) considered within the International Standards for ergonomics. In fact, the innovative human–robot collaboration (HRC) systems are widening the number of work motor tasks that cannot be assessed. On the other hand, new sensor-based tools for biomechanical risk assessment could be used for both quantitative “direct instrumental evaluations” and “rating of standard methods”, allowing certain improvements over traditional methods. In this light, this Letter aims at detecting the need for revising the standards for human ergonomics and biomechanical risk assessment by analyzing the WMDs prevalence and incidence; additionally, the strengths and weaknesses of traditional methods listed within the International Standards for manual handling activities and the next challenges needed for their revision are considered. As a representative example, the discussion is referred to the lifting of heavy loads where the revision should include the use of sensor-based tools for biomechanical risk assessment during lifting performed with the use of exoskeletons, by more than one person (team lifting) and when the traditional methods cannot be applied. The wearability of sensing and feedback sensors in addition to human augmentation technologies allows for increasing workers’ awareness about possible risks and enhance the effectiveness and safety during the execution of in many manual handling activities.