A survey of stakeholder perspectives on a proposed combined exoskeleton-wheelchair technology

Background: Exoskeleton technology has potential benefits for wheelchair users' health and mobility. However, there are practical barriers to their everyday use as a mobility device. In particular, challenges related to travelling longer distances and transitioning between using a wheelchair and exoskeleton walking may present significant deterrents to regular exoskeleton use. In an effort to remove these barriers, a combined exoskeleton-wheelchair concept ('COMBO') has been proposed, which aims to achieve the benefits of both these mobility technologies. Given the inherent importance of including user-stakeholder opinions when designing an assistive technology solution, a study was undertaken to explore the perspectives of wheelchair users and healthcare professionals on the proposed conceptual design of the COMBO. Methods: An online survey with quantitative and qualitative components was conducted with wheelchair users and healthcare professionals working directly with individuals with mobility impairments. Respondents rated whether they would use or recommend a COMBO for four potential reasons. Nine design features were rated and compared in terms of their importance. Content analysis was used to analyze data from an open-ended question regarding additional perceptions about using or recommending a COMBO. Results: A total of 481 survey responses were analyzed, 354 from wheelchair users and 127 from healthcare professionals. Potential health benefits was the most highly rated reason for potential use or recommendation of a COMBO. Of the 9 design features, 2 had a median rating of very important: inclusion of a fall-protection mechanism, and the ability for the operator to use their hands while standing. Qualitative findings indicated that health and physical benefits, use for daily life activities, and psychosocial benefits were important considerations in whether to use or recommend the COMBO. Conclusions: This study captures the opinions and perspectives of two stakeholder groups for an exoskeleton-wheelchair hybrid device. It also emphasizes the importance of fall-protection, hand-use capabilities and enabling functional activities. Findings from this study can be utilized to provide insight for the refinement of the COMBO concept, as well as to guide more general mobility device research and development.