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

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.

[1]  Gail M. Williams,et al.  A systematic review of the global prevalence of low back pain. , 2012, Arthritis and rheumatism.

[2]  Self‐efficacy is more important than fear of movement in mediating the relationship between pain and disability in chronic low back pain , 2011 .

[3]  Idsart Kingma,et al.  Cumulative mechanical low-back load at work is a determinant of low-back pain , 2014, Occupational and Environmental Medicine.

[4]  J. Creswell,et al.  Qualitative Research Designs , 2007 .

[5]  L. M. Costa,et al.  Self‐efficacy is more important than fear of movement in mediating the relationship between pain and disability in chronic low back pain , 2011, European journal of pain.

[6]  Homayoon Kazerooni,et al.  Lower Extremity Exoskeleton Reduces Back Forces in Lifting , 2009 .

[7]  A. Field,et al.  A Systematic Review of Psychological Factors as Predictors of Chronicity/Disability in Prospective Cohorts of Low Back Pain , 2002, Spine.

[8]  Axel S. Koopman,et al.  SPEXOR passive spinal exoskeleton decreases metabolic cost during symmetric repetitive lifting , 2019, European Journal of Applied Physiology.

[9]  R Z Omar,et al.  Factors affecting self-efficacy and pain intensity in patients with chronic musculoskeletal pain seen in a specialist rheumatology pain clinic. , 2008, Rheumatology.

[10]  Christine Cedraschi,et al.  Non-specific low back pain , 2012, The Lancet.

[11]  Deborah Hill,et al.  WHAT ARE USER PERSPECTIVES OF EXOSKELETON TECHNOLOGY? A LITERATURE REVIEW , 2017, International Journal of Technology Assessment in Health Care.

[12]  P. Lindberg,et al.  Self-efficacy, fear avoidance, and pain intensity as predictors of disability in subacute and chronic musculoskeletal pain patients in primary health care , 2004, Pain.

[13]  M. Frings-Dresen,et al.  The effect of lifting during work on low back pain: a health impact assessment based on a meta-analysis , 2014, Occupational and Environmental Medicine.

[14]  George Dowswell,et al.  Guest editorial: public and user 'involvement' in the UK National Health Service. , 2002, Health & social care in the community.

[15]  M. Doef,et al.  The Job Demand-Control (-Support) Model and psychological well-being: A review of 20 years of empirical research , 1999 .

[16]  Martin Underwood,et al.  Non-specific low back pain , 2012, The Lancet.

[17]  Frank Krause,et al.  Exoskeletons for industrial application and their potential effects on physical work load , 2016, Ergonomics.

[18]  Michiel P de Looze,et al.  Biomechanical evaluation of a new passive back support exoskeleton. , 2020, Journal of biomechanics.

[19]  Vincent Nourry.  [Spinal disorders]. , 2012, Soins Gérontologie.

[20]  W. Marras,et al.  The future of research in understanding and controlling work-related low back disorders , 2005, Ergonomics.

[21]  Fadi A Fathallah,et al.  Effect of a personal weight transfer device on muscle activities and joint flexions in the stooped posture. , 2013, Journal of electromyography and kinesiology : official journal of the International Society of Electrophysiological Kinesiology.

[22]  Idsart Kingma,et al.  Effects of a passive exoskeleton on the mechanical loading of the low back in static holding tasks. , 2019, Journal of biomechanics.

[23]  P. Oesch,et al.  Development of a Modified Version of the Spinal Function Sort (M-SFS): A Mixed Method Approach , 2015, Journal of Occupational Rehabilitation.

[24]  H. Houdijk,et al.  The effect of a passive trunk exoskeleton on functional performance in healthy individuals. , 2018, Applied ergonomics.

[25]  Max Aebi,et al.  Spinal Disorders: Fundamentals of Diagnosis and Treatment , 2009, American Journal of Neuroradiology.

[26]  Sarah Milne.  Self-efficacy in changing societies , 1999, Journal of health psychology.

[27]  Michael J Agnew,et al.  Effectiveness of an on-body lifting aid at reducing low back physical demands during an automotive assembly task: assessment of EMG response and user acceptability. , 2009, Applied ergonomics.

[28]  Virginia Braun,et al.  Successful Qualitative Research: A practical guide for beginners , 2013, QMiP Bulletin.

[29]  J. Chenot,et al.  Non-Specific Low Back Pain. , 2017, Deutsches Arzteblatt international.

[30]  Xitong Guo,et al.  User acceptance of mobile health services from users’ perspectives: The role of self-efficacy and response-efficacy in technology acceptance , 2017, Informatics for health & social care.

[31]  P. Oesch,et al.  Measurement Properties of the Modified Spinal Function Sort (M-SFS): Is It Reliable and Valid in Workers with Chronic Musculoskeletal Pain? , 2017, Journal of Occupational Rehabilitation.

[32]  Bram Vanderborght,et al.  Passive Back Support Exoskeleton Improves Range of Motion Using Flexible Beams , 2018, Front. Robot. AI.

[33]  Joan M Stevenson,et al.  Mathematical and empirical proof of principle for an on-body personal lift augmentation device (PLAD). , 2007, Journal of biomechanics.

[34]  Richard A. Krueger,et al.  Moderating Focus Groups , 1997 .

[35]  D. Cole,et al.  Individual participant data meta-analysis of mechanical workplace risk factors and low back pain. , 2012, American journal of public health.

[36]  Gillian R. Hayes,et al.  (In)Visibility in Disability and Assistive Technology , 2017, ACM Trans. Access. Comput..

[37]  ANNETTE DE VITO DABBS,et al.  User-Centered Design and Interactive Health Technologies for Patients , 2009, Computers, informatics, nursing : CIN.

[38]  D. Mertens.  Research and Evaluation in Education and Psychology: Integrating Diversity with Quantitative, Qualitative, and Mixed Methods , 1997 .

[39]  A. Bandura.  Self-efficacy in Changing Societies: Contents , 1995 .

[40]  Fred D. Davis.  Perceived Usefulness, Perceived Ease of Use, and User Acceptance of Information Technology , 1989, MIS Q..

[41]  Olalekan Uthman,et al.  Absence from work and return to work in people with back pain: a systematic review and meta-analysis , 2013, Occupational and Environmental Medicine.

[42]  Saskia J. Baltrusch,et al.  Perspectives of End Users on the Potential Use of Trunk Exoskeletons for People With Low-Back Pain: A Focus Group Study , 2020, Hum. Factors.