¹Department of Population Health, New York University, New York, United States

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Introduction: Work-related musculoskeletal disorders (WMSDs) are one of the primary causes of disability among the general working population [1]. About three out of five employees of EU member states suffer from WMSDs [2]. As a result, WMSDs pose a large (economic) burden on the affected workers, employers and health care systems [3]. Managing WMSDs is a major challenge for occupational health and safety, where occupational health and safety measures must mitigate or prevent the onset of new or aggravation of existing WMSDs. These measures address important work-related risk factors, including frequent lifting and carrying, heavy physical work, highly repetitive movements, and awkward static and dynamic postures [4]. Exoskeletons, which are technical systems worn on the human body that have a mechanical effect on the body [5], [6] have rapidly emerged for occupational applications, aiming to support functions of the musculoskeletal system during physical work [7].

Methods: The number of publications on the topic of occupational exoskeletons has increased exponentially in recent years [8]. Only a selection of recent literature reviews [9], (national) guidelines [7], longitudinal field studies [10], and laboratory studies [11] on exoskeletons will be explicated regarding their potential for reducing physical demands and preventing WMSDs in workers.

Results: Publications mainly report on evaluations of exoskeletons in various occupations regarding reductions in physical demands, including local muscle activity, joint forces and moments, and perceived feelings of discomfort, exertion or pain [9]. Only few publications reported more direct associations with WMSD prevalence, simply because only few longitudinal field studies have been performed and published so far [12].

Discussion: Knowledge about the effects of exoskeletons on the reduction of physical demands at the workplace are based mainly on the direct or short-term effects of wearing exoskeletons [13]. Thus, concrete evidence that exoskeletons can actually prevent WMSDs is very limited. In addition, scientific research addresses aspects of risk assessment when working with exoskeletons, supporting and hindering factors for the introduction of exoskeletons and their practical application and acceptance by employees.

Outlook: Overall, there is a great need for future longitudinal (field) studies of sufficient methodological quality that investigate the use of exoskeletons for WMSD-prevention among populations varying in age, gender, health status and occupation. The fact that there is no clear indication of the frequency or duration of exoskeleton use during the working day [14] and that the level of support provided by the exoskeletons varies greatly [15] indicates that fundamental questions still need to be answered. Before extensive longitudinal studies are carried out, these unsolved questions should be addressed.

Literatur

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[6] DIN NA 023-00-08 GA Exoskelette 2024.
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[11] Raghuraman RN, Srinivasan D. The effects of soft vs. rigid back-support exoskeletons on trunk dynamic stability and trunk-pelvis coordination in young and old adults during repetitive lifting. J Biomech. 2024 Nov;176:112348. DOI: 10.1016/j.jbiomech.2024.112348
[12] Moulart M, Olivier N, Giovanelli Y, Marin F. Subjective assessment of a lumbar exoskeleton's impact on lower back pain in a real work situation. Heliyon. 2022 Nov 9;8(11):e11420. DOI: 10.1016/j.heliyon.2022.e11420
[13] Cha JS, Athanasiadis DI, Asadi H, Stefanidis D, Nussbaum MA, Yu D. Evaluation of a passive arm-support exoskeleton for surgical team members: Results from live surgeries. J Safety Res. 2024 Jun;89:322-330. DOI: 10.1016/j.jsr.2024.02.003
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