Passive Trunk Exoskeleton Acceptability and Effects on Self-efficacy in Employees with Low-Back Pain: A Mixed Method Approach

Abstract

Purpose Determinants of successfully introducing passive exoskeletons in the working environment to decrease mechanical loading on the back, are acceptability of the device to management and employees, including self-efficacy of employees when using the device. Therefore, the aim of this study was to assess self-efficacy of employees with low-back pain when using an exoskeleton and the acceptability of such a device to these employees and their managers. Methods We used a mixed method approach. We quantitatively assessed the change in self-efficacy of 17 employees with low-back pain when performing daily activity tasks with the exoskeleton, using the modified spinal function sort (M-SFS). Qualitatively, we conducted a focus group with employees and a double interview with two managers to add more insight and understandings into changes in self-efficacy and to discuss challenges of implementing an exoskeleton in the working environment. Results Self-efficacy significantly increased by 7% when using the exoskeleton. Employees acknowledged the flexibility of the exoskeleton being advantageous to current static external lifting devices, which confirmed the increase of self-efficacy in both static and dynamic tasks. Individual data showed that the increase in self-efficacy was largest for participants, being greatly restricted by their low-back pain. In the focus group, employees confirmed that they are mostly open to wearing the exoskeleton if they suffer from low-back pain. Conclusion If potential challenges, e.g. visibility and potential refusal of wearing an exoskeleton are considered in the implementation strategy, acceptability of and self-efficacy in using the passive trunk exoskeleton would be further improved, potentially contributing to reduced risk of low-back pain.

Comparison of Subjective Responses of Low Back Pain Patients and Asymptomatic Controls to Use of Spinal Exoskeleton during Simple Load Lifting Tasks: A Pilot Study

“…On the other hand, asymptomatic individuals seemed to not be willing to endure this downside, with no apparent benefit. To better elucidate the reasons for these differences, focus groups should be implemented [ 15 , 16 ] in the future. Indeed, it has been previously stressed by focus group participants that they see a potential of the exoskeleton use in rehabilitation, but not prevention [ 15 ].…”

“…However, a major issue that remains mostly unresolved, is the subjective perception and acceptance of the device by the users, for which the abovementioned studies have shown mixed and inconclusive results. This issue has been lately addressed with qualitative methods, such as focus groups [ 15 , 16 ]. Although some concerns were expressed, LBP patients acknowledged the potential of the exoskeleton and generally show a willingness to use it [ 15 , 16 ].…”

“…This issue has been lately addressed with qualitative methods, such as focus groups [ 15 , 16 ]. Although some concerns were expressed, LBP patients acknowledged the potential of the exoskeleton and generally show a willingness to use it [ 15 , 16 ]. While this advocates the use of exoskeletons for rehabilitation and vocational reintegration, aversion to use the exoskeleton for prevention of LBP could be expected by asymptomatic individuals.…”

“…While the aim of the exoskeleton development is to provide devices that could be used for both prevention or rehabilitation of LBP [ 4 ], the context of their use could influence the subjective responses and willingness to use the exoskeletons. Luggage handlers in a focus group reported that they would be willing to use an exoskeleton for rehabilitation, but not prevention purposes [ 15 ]. Based on the current evidence, it could be assumed that LBP patients would be willing to use the exoskeletons [ 5 , 14 , 15 ], while less is known about the attitudes of asymptomatic individuals.…”

“…Luggage handlers in a focus group reported that they would be willing to use an exoskeleton for rehabilitation, but not prevention purposes [ 15 ]. Based on the current evidence, it could be assumed that LBP patients would be willing to use the exoskeletons [ 5 , 14 , 15 ], while less is known about the attitudes of asymptomatic individuals. If the differences exist, the exoskeleton developers should consider different models for prevention and rehabilitation purposes.…”