¹Institute of Occupational and Social Medicine and Health Services Research, University Hospital of Tübingen, Tübingen, Germany
²Institute for Occupational Safety and Health of the German Social Accident Insurance e. V. (IFA), Sankt Augustin, Germany
³Health Centre North, AUDI AG, Ingolstadt, Germany
⁴Federal Institute for Occupational Safety and Health, Berlin, Germany
⁵German Social Accident Insurance Institution for the Trade and Logistics Industry, Mannheim, Germany

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Methods: Following the PRISMA guidelines, systematic electronic database searches were conducted on 14 February 2025 in four databases (MEDLINE (PubMed), CINAHL (Ebsco), CENTRAL (Ovid), and EMBASE (Ovid)) and one trial register (ClinicalTrials.gov). The screening process was performed in two phases and independently by two review authors. The effect of intervention, i.e. using an exoskeleton, on pre-established outcomes will be calculated using standardized mean differences for continuous outcomes in multiple meta-analyses with Covidence software. The review protocol is registered in PROSPERO (number: CRD42024554999). Risk of bias and the quality of evidence will be assessed using appropriate standardized approaches.

Results: A total of 1,414 records were identified through searching the databases, with 53 further records retrieved from the trial register. After removing 433 duplicates, 1,034 unique records remained for the screening of titles and abstracts. Subsequently, 304 articles were assessed in full-text screening, of which 199 records were included for data extraction. Among these 199 articles, only 4 studies (5 full-text articles) were identified as longitudinal field studies that could provide evidence beyond the acute effects of exoskeletons. The vast majority of the literature still only refers to the acute effects of exoskeletons. Following this, we plan to finish data extraction and finalize the number of included studies in the meta-analysis and assess risk of bias and quality of evidence.

Conclusion: Implementing exoskeletons in occupational settings may have the potential to reduce the acute physical stress and strain of the workers. The objective of this updated systematic review and meta-analysis is to conduct a comprehensive synthesis of the most recent findings, publications, and developments in this highly dynamic field and provide insight into the effect of using exoskeletons in work tasks. The body of evidence beyond acute effects of exoskeletons on physical stress and strain is still limited. The final conclusion in consideration of the risk of bias, the quality of evidence, and the effectiveness of exoskeleton use in occupational contexts, will be outlined after finalizing the systematic review and meta-analysis.