OCCUPATIONAL APPLICATIONS This guideline includes 20 recommendations and four key statements that achieved consensus or strong consensus regarding the application of exoskeletons in the workplace for the prevention of musculoskeletal complaints and diseases, the general use and implementation of exoskeletons, and recommendations for risk assessment. The guideline is intended for company physicians, occupational physicians, ergonomists, occupational safety specialists, and employers, and serves as information for all other actors in practical occupational safety. Due to the lack of evidence from the scientific literature, the recommendations and key statements are the result of expert discussions that were conducted at a consensus conference in accordance with the Regulations of the Association of the Scientific Medical Societies in Germany, moderated by an external consultant.
Keywords: Literature review; assistive device; musculoskeletal disorders; musculoskeletal strain; musculoskeletal stress; workload.
TECHNICAL ABSTRACT Background The prevention of work-related musculoskeletal complaints and diseases has high priority, considering the prevalence of musculoskeletal complaints and diseases and the associated high burden on health care systems, the economy, and the people affected. Purpose: This guideline provided recommendations for potential applications of exoskeletons in the workplace for the primary, secondary, and tertiary prevention of musculoskeletal complaints and diseases, general recommendations on the use and implementation of exoskeletons, and recommendations on risk assessment. Methods: A systematic literature search, a survey among exoskeleton manufacturers and companies using exoskeletons, and expert discussions formed the basis of the formulated recommendations and key statements. For reaching consensus on the recommendations and key statements, we applied the Nominal Group and Delphi Techniques under the supervision of an external, independent moderator. Results: We formulated 20 recommendations and four key statements, all of which reached consensus or strong consensus. Conclusion: No answers could be found in the current scientific literature to the central questions in this guideline about primary, secondary, and tertiary prevention. We outline five main directions for future research on exoskeletons in occupational settings. First, using exoskeletons for prevention should be investigated using randomized controlled trials. Second, the effects of exoskeletons on work-related musculoskeletal stress and strain should be investigated both in the body region intended to be supported by the exoskeleton as well as in other non-supported body regions. Third, the effects of exoskeletons should be investigated in samples varying in age, gender, and health status, as well as during different occupational activities. Fourth, a specific risk assessment tool for exoskeletons in occupational settings should be developed and implemented to meet and evaluate the applicable occupational health and safety standards. Fifth, there is a need to expand upon the very limited social science research on the impacts of exoskeletons on employee professional understanding, social role understanding, or diversity.