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

Differences in neural strategies explain exoskeleton-related benefits in performance over time during complex visuomotor wiring tasks

This study evaluated the effects of a passive shoulder exoskeleton on neural, muscular, and perceptual responses during a three-day visuomotor wiring task involving overhead reaching. The task required participants to sequentially connect 40 randomly arranged targets on a two-dimensional board using a wire, engaging both motor and cognitive processes such as working memory and visual search. Twenty-four novice participants, balanced by sex, were randomly assigned to either an exoskeleton or a control group. The exoskeleton group demonstrated reduced upper extremity muscle activity but increased lower back activity. Despite similar perceived exertion levels between the groups, exoskeleton users reported lower mental demands, quicker visual searches, and higher task accuracy over time, all while exhibiting comparable task completion times. Neural analysis revealed greater functional specialization in the exoskeleton group, whereas the control group prioritized fronto-motor network integration. These findings provide valuable insights for practitioners contemplating the implementation of exoskeletons for tasks requiring both physical and cognitive engagement effort.

User Experiences and Adoption Factors for a Back-Support Exosuit in Automotive Logistics: Results from Field Testing up to 18 Months

Occupational ApplicationsWe interviewed 24 automotive logistic workers who had used (or stopped using) a soft back-support exoskeleton (exosuit). These workers generally recognized potentially benefits of back-support exosuits, with 11 continuing use. Their use was primarily influenced by usability, compatibility, and comfort factors. We found wide variability in use patterns and adaptation periods, and that there were specific design concerns and concerns regarding thermal discomfort. To enhance long-term adoption of exosuits in industrial settings, organizations should consider: 1) implementing flexible, individualized training programs addressing specific usability challenges; 2) adopting a voluntary approach accommodating varied adaptation needs; 3) providing comprehensive education on potential health benefits; 4) using peer demonstrations to promote acceptance; and 5) collaborating with manufacturers to improve designs based on user feedback. These strategies may help enhance acceptance and sustained use of exosuits, potentially contributing to more effective support for occupational health during manual material handling tasks.

Preference-based assistance optimization for lifting and lowering with a soft back exosuit

Wearable robotic devices have become increasingly prevalent in both occupational and rehabilitative settings, yet their widespread adoption remains inhibited by usability barriers related to comfort, restriction, and noticeable functional benefits. Acknowledging the importance of user perception in this context, this study explores preference-based controller optimization for a back exosuit that assists lifting. Considering the high mental and metabolic effort discrete motor tasks impose, we used a forced-choice Bayesian Optimization approach that promotes sampling efficiency by leveraging domain knowledge about just noticeable differences between assistance settings. Optimizing over two control parameters, preferred settings were consistent within and uniquely different between participants. We discovered that overall, participants preferred asymmetric parameter configurations with more lifting than lowering assistance, and that preferences were sensitive to user anthropometrics. These findings highlight the potential of perceptually guided assistance optimization for wearable robotic devices, marking a step toward more pervasive adoption of these systems in the real world.

Perspectives of Mining Personnel on Adopting Occupational Exoskeletons: Comparisons Between a Developed and a Developing Country

Occupational exoskeletons (EXOs) have received growing attention as a new ergonomic intervention to reduce physical demands in various industries (e.g., manufacturing, logistics, construction, and agriculture). However, their potential use in mining has not yet been reported. Survey data (n = 135) were obtained from mining workers in the United States (US) and Indonesia (ID). Qualitative and frequency analyses were used to summarize and compare respondents' perceived barriers, benefits, and promoters to EXO use and adoption. Beta regression analyses were also used to examine whether the perceived likelihood to use arm-support EXOs or back-support EXOs differed between the countries and was affected by demographic or job characteristics, or by perceptions regarding EXOs. Both US and ID respondents reported potential benefits of EXOs for physically demanding tasks such as lifting and overhead work, and they shared concerns about adaptation, uncertainty or lack of knowledge, confined spaces, device weight, potential failure or damage, and costs. However, some key differences also emerged: US respondents were more likely to consider using arm-support EXOs and back-support EXOs, despite expressing concerns about their use; ID respondents, although they reported more existing health and safety hazards, appeared more hesitant about adopting EXOs, possibly due to these additional hazards. These results demonstrate that miners appear to have an interest in EXOs but also emphasize the need to ensure task compatibility, comfort, and affordability to ensure the safe and effective adoption of EXO technology in mining in both developed and developing countries.

Supplementary Information

The online version contains supplementary material available at 10.1007/s42461-025-01189-1.

From the idea to the user: a pragmatic multifaceted approach to testing occupational exoskeletons

Assessment of occupational exoskeletons should ideally include longitudinal and multistage studies in real working scenarios to prove their effectiveness and sustainability in real in-field contexts and to help generalize the findings for specific scenarios. This work presents a comprehensive assessment methodology implemented as a multistage experimental campaign for rail industry workers using a back-support exoskeleton (StreamEXO). This work demonstrates that a sector/task-specific exoskeleton developed to address work task-specific requirements generates beneficial performance and user experience results. The experimental work in this paper involves collecting data from nine workers over multiple days of testing. During this testing, workers did not report hindrances to their work operations, with an acceptance rate of 86%. In addition, worker fatigue was reduced by 16.9% as measured through metabolic consumption, and 51% when assessed by perceived effort. This work supports the hypothesis that sector/task-specific exoskeletons when tailored to meet the needs of workers and the work tasks can produce demonstrable benefits in real industrial sectors.

From unknown to familiar: An exploratory longitudinal field study on occupational exoskeletons adoption

Occupational exoskeletons hold promise in preventing musculoskeletal disorders, but their effectiveness relies on their long-term use by workers. This study aims to characterize the adoption process of occupational exoskeletons by analyzing the experiences of 25 operators. Using a mixed-methods approach, both quantitative and qualitative data were collected before and during a four-week familiarization period. We primarily focused on users' expectations, subjective assessments over time, and initial experiences. Findings elucidate shifts in operators' perceptions of the devices over time. Through their narratives, we highlight how exoskeleton use impact operators' movements and the subsequent adaptations. Operators demonstrated diverse exploratory behaviors, indicating their efforts to get to grips with the effects of exoskeletons in their own ways. This study offers insights into the initial stages of occupational exoskeleton adoption, thus enriching our comprehension of rejection patterns and pathways toward their widespread acceptance.

Active back exosuits demonstrate positive usability perceptions that drive intention-to-use in the field among logistic warehouse workers

Back exosuits offer the potential to reduce occupational back injuries but require in-field acceptance and use to realize this potential. For this study, 146 employees trialed an active back exosuit in the field for 4 h, completing an acceptance usability survey. Comparing the 80% of employees willing to continue wearing this device (N = 117) to those who were not (N = 29) revealed that employees willing to wear this device for a longer-term study generally were more likely to perceive this back exosuit to be effective (helpful) and compatible (minimally disruptive) to their everyday work. Using an optimal tree approach, we demonstrate that intent-to-use could be predicted with 78% accuracy by interacting features of perceived exosuit effectiveness and work compatibility. This study reinforces the importance of task matching, noticeable relief, and unobtrusive design to facilitate short-term employee acceptance of industrial wearable robotic technology.

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.

Arm-support exoskeleton reduces shoulder muscle activity in ceiling construction

The objective of this study was to assess the efficacy and user's impression of an arm-support exoskeleton in complex and realistic ceiling construction tasks. 11 construction workers performed 9 tasks. We determined objective and subjective efficacy of the exoskeleton by measuring shoulder muscle activity and perceived exertion. User's impression was assessed by questionnaires on expected support, perceived support, perceived hindrance and future intention to use the exoskeleton. Wearing the exoskeleton yielded persistent reductions in shoulder muscle activity of up to 58% and decreased perceived exertion. Participants reported limited perceived hindrance by the exoskeleton, as also indicated by no increase in antagonistic muscle activity. The findings demonstrate the high potential of an arm-support exoskeleton for unloading the shoulder muscles when used in the dynamic and versatile working environment of a ceiling construction worker, which is in line with the consistent intention of the workers to use the exoskeleton in the future.Practitioner Summary: The majority of research focuses on the effect of using an arm-support exoskeleton during isolated postures and prescribed movements. We investigated the efficacy of an exoskeleton during a complex and realistic work, namely ceiling construction. Shoulder muscle activity was lower in almost all tasks when wearing the exoskeleton.

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.

Biomechanical Effects of Using a Passive Exoskeleton for the Upper Limb in Industrial Manufacturing Activities: A Pilot Study

This study investigates the biomechanical impact of a passive Arm-Support Exoskeleton (ASE) on workers in wool textile processing. Eight workers, equipped with surface electrodes for electromyography (EMG) recording, performed three industrial tasks, with and without the exoskeleton. All tasks were performed in an upright stance involving repetitive upper limbs actions and overhead work, each presenting different physical demands in terms of cycle duration, load handling and percentage of cycle time with shoulder flexion over 80°. The use of ASE consistently lowered muscle activity in the anterior and medial deltoid compared to the free condition (reduction in signal Root Mean Square (RMS) -21.6% and -13.6%, respectively), while no difference was found for the Erector Spinae Longissimus (ESL) muscle. All workers reported complete satisfaction with the ASE effectiveness as rated on Quebec User Evaluation of Satisfaction with Assistive Technology (QUEST), and 62% of the subjects rated the usability score as very high (>80 System Usability Scale (SUS)). The reduction in shoulder flexor muscle activity during the performance of industrial tasks is not correlated to the level of ergonomic risk involved. This preliminary study affirms the potential adoption of ASE as support for repetitive activities in wool textile processing, emphasizing its efficacy in reducing shoulder muscle activity. Positive worker acceptance and intention to use ASE supports its broader adoption as a preventive tool in the occupational sector.

Effects of upper-limb exoskeleton on muscle activity in tasks requiring arm elevation: Part II - In-field experiments in construction industry settings

Background

The body of literature regarding the use of an upper limb exoskeleton during authentic working conditions is sparse.

Objective

The aim of this study was to evaluate the effectiveness of an upper limb exoskeleton in reducing muscle strain during authentic industrial construction work.

Methods

Fifteen male participants, comprising of roofers, scaffolders, builders, bricklayers, and graders performing overhead work participated in the study. During work without (REF) and with exoskeleton (EXO), muscle activity from 8 muscles, heart rate (HR), metabolic equivalent (MET), and upper arm elevation angles were recorded.

Results

When using the exoskeleton, a significant reduction of 20.2% in average muscle activity of 8 muscles was found. The largest effect focused on m. deltoideus, where 46.2 and 32.2% reduction occurred in medial and anterior parts of the muscle, respectively. HR and MET were unaffected. Upper arm elevation angles were similar between REF and EXO, indicating equal biomechanical loading.

Conclusions

This study indicates that exoskeletons show great promise in reducing the potential for musculoskeletal strain during authentic overhead construction work.

Addressing Exoskeleton Implementation Challenges: Case Studies of Non-Acceptance in Agriculture

OBJECTIVES

The objective of this study was to detect success and failure factors for the implementation of passive exoskeletons in agriculture. Exoskeletons have been shown to reduce musculoskeletal loads during lab-based manual tasks, but long-term implementation experiences in agriculture are lacking.

METHODS

We analyzed four intervention studies in agriculture focusing on methodological and contextual reasons why the trials were successful or unsuccessful. The study context, attempted intervention, and data collection of each field trial is compared. In the absence of long-term studies investigating the implementation and effectiveness of exoskeletons in agriculture, a set of multi-week pilot trials were initiated among German market vegetable farms and French vineyards from 2019 to 2022. Participant ratings, farm characteristics (e.g. employment duration and payment scheme) and intervention implementation characteristics (e.g. participation in implementation or language barriers) were analyzed using a mixed-methods approach to identify success and failure factors.

RESULTS

The comparison of the studies showed that despite the organizational issues, there were several practical issues that limit the success of exoskeleton use in agriculture. We observed that participant rejection of the intervention is a major barrier to successfully conducting long-term field trials in agriculture. Factors like pain, discomfort, heat stress, or a lack of perceived benefits have been identified as failure factors but also the implementation process itself.

CONCLUSION

In addition to careful targeting of trial sites and inclusion of participatory elements in the implementation plan, successful implementation of exoskeletons in agriculture requires fundamental human factors development of the exoskeletons themselves. This will require better matching the physical needs of the workers, the production needs of the tasks, and compatibility with the environment.

Objective and subjective evaluation of a passive low-back exoskeleton during simulated logistics tasks

Musculoskeletal disorders remain the most common work-related health problem in the European Union. The most common work-related musculoskeletal disorder reported by workers is backache, especially in the logistics sector. Thus, this article aims to evaluate the effects of a commercial passive low-back exoskeleton during simulated logistics tasks. Thirty participants were recruited for this study. Typical logistics tasks were simulated in a laboratory environment. Cross-over research design was utilized to assess the effects of the exoskeleton on heart rate, trunk inclination, trunk acceleration, throughput, and perceived exertion. Also, usability and acceptance were obtained using a custom questionnaire. We found mostly non-significant differences. Effects on throughput varied widely between workplaces. Usability ratings were poor and acceptance moderate. The study suggests that a holistic evaluation and implementation approach for industrial exoskeletons is necessary. Further, prior to exoskeleton implementation, workplace adaptation might be required.

Evaluation of U.S. Army Soldiers wearing a back exosuit during a field training exercise

Back overuse injuries are a significant problem in the U.S. Army, responsible for nearly a quarter of musculoskeletal injuries. Back exosuits are wearable devices that relieve musculoskeletal strain, make lifting easier, and could potentially reduce Soldier overuse injuries. But published studies have not evaluated exosuits during realistic field operations to assess acceptability to Soldiers. We tested a back exosuit on field artillery Soldiers during a field training exercise. Afterward, Soldiers completed a survey to quantify their satisfaction, intent to use, and performance impact of the exosuit. Feedback was overwhelmingly positive: Approximately 90% of Soldiers reported that exosuits increased their ability to perform their duties, and 100% said that if the exosuit were further developed and made available to them, they would be likely to wear it. These numerical survey results indicated that exosuits can provide a practical and acceptable way to assist lifting and augment physical performance during realistic Army operations without interfering with other duties.

Manufacturing Industry Stakeholder Perspectives on Occupational Exoskeletons: Changes after a Brief Exposure to Exoskeletons

OCCUPATIONAL APPLICATIONSMultiple occupational exoskeletons have been developed recently with potential to reduce physical demands, muscle fatigue, and risk of over-exertion injuries in manufacturing, yet there are currently challenges in practical, large-scale deployment. We explored how stakeholder perceptions of exoskeletons were affected by exposure to passive arm- and back-support exoskeletons. Our outcomes indicate that even brief exposure to exoskeletons can positively influence worker and stakeholder perceptions on the usefulness and safety of exoskeletons. However, worker concerns about device usability and acceptability in the field were not mitigated by such brief exposure. This work may help manufacturing industry stakeholders understand what technology-adoption factors need further consideration when planning for exoskeleton deployment.

Wearable Motion Capture Devices for the Prevention of Work-Related Musculoskeletal Disorders in Ergonomics-An Overview of Current Applications, Challenges, and Future Opportunities

Work-related musculoskeletal disorders (WMSDs) are a major contributor to disability worldwide and substantial societal costs. The use of wearable motion capture instruments has a role in preventing WMSDs by contributing to improvements in exposure and risk assessment and potentially improved effectiveness in work technique training. Given the versatile potential for wearables, this article aims to provide an overview of their application related to the prevention of WMSDs of the trunk and upper limbs and discusses challenges for the technology to support prevention measures and future opportunities, including future research needs. The relevant literature was identified from a screening of recent systematic literature reviews and overviews, and more recent studies were identified by a literature search using the Web of Science platform. Wearable technology enables continuous measurements of multiple body segments of superior accuracy and precision compared to observational tools. The technology also enables real-time visualization of exposures, automatic analyses, and real-time feedback to the user. While miniaturization and improved usability and wearability can expand the use also to more occupational settings and increase use among occupational safety and health practitioners, several fundamental challenges remain to be resolved. The future opportunities of increased usage of wearable motion capture devices for the prevention of work-related musculoskeletal disorders may require more international collaborations for creating common standards for measurements, analyses, and exposure metrics, which can be related to epidemiologically based risk categories for work-related musculoskeletal disorders.

Industrial exoskeletons from bench to field: Human-machine interface and user experience in occupational settings and tasks

Objective

Work-related musculoskeletal disorders (WRMSDs) are considered nowadays the most serious issue in the Occupational Health and Safety field and industrial exoskeletons appear to be a new approach to addressing this medical burden. A systematic review has been carried out to analyze the real-life data of the application of exoskeletons in work settings considering the subjective responses of workers.

Methods

The review was registered on PROSPERO. The literature search and its report have been performed following the PRISMA guidelines. A comprehensive literature search was performed in PubMed, EMBASE, Web of Science, and Scopus.

Results

Twenty-four original studies were included in the literature review; 42% of the papers retrieved included automobilist industry workers, 17% of the studies evaluated the use of exoskeletons in logistic facilities, and 17% of articles involved healthcare. The remaining six papers recruited farmers, plasterers, wasting collectors, construction workers, and other workmen. All the papers selected tested the use of passive exoskeletons, supporting upper arms or back. Usability, perceived comfort, perceived exertion and fatigue, acceptability and intention to use, occupational safety and health, and job performance and productivity were the main topic analyzed.

Conclusion

Exoskeletons are not a fix-all technology, neither for workers nor for job tasks; they tend to show more of their potential in static activities, while in dynamic tasks, they can obstacle regular job performance. Comfort and easiness of use are the key factors influencing the user's experience. More research is needed to determine the most effective and safe ways to implement exoskeleton use in occupational settings.

Systematic review registration

https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=275728, identifier CRD42021275728.

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.