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Short-Term Effects of a Passive Spinal Exoskeleton on Functional Performance, Discomfort and User Satisfaction in Patients with Low Back Pain

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Abstract

Purpose Low back pain (LBP) remains a major worldwide healthcare issue. Recently, spinal exoskeletons were proposed as a potentially useful solution for LBP prevention and vocational reintegration for people who perform heavy load lifting, repetitive movements or work in prolonged static postures. The purpose of this study was to investigate how patients with LBP respond to the novel passive SPEXOR exoskeleton regarding functional performance, discomfort and general user impression. Methods Fourteen patients, with low to moderate LBP (2–7 on a 0–10 scale), performed 12 functional tasks with and without the exoskeleton. In addition to objective performance measures, participants subjectively assessed the level of local low back discomfort, task difficulty and general discomfort on a 0–10 visual analogue scales. Results The SPEXOR exoskeleton had favourable effects on performance and local discomfort during prolonged static forward bending. Minor reductions in performance were observed for sit-stand and ladder climbing tasks. The discomfort associated with the exoskeleton was generally low to moderate (median < 4), except for the 6-min walk test (median = 4.5), which is likely due to the weight of the device and obstruction of upper limb movement. The general impressions were mostly positive, with good adjustability, low interference with the movement and moderate support reported by the participants. Conclusion The SPEXOR exoskeleton is potentially useful for LBP prevention or management, however, further improvements are needed to provide higher levels support during heavy load lifting.

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References

  1. Fatoye F, Gebrye T, Odeyemi I. Real-world incidence and prevalence of low back pain using routinely collected data. Rheumatol Int. 2019;39:619–26.

    Article  Google Scholar 

  2. Mehra M, Hill K, Nicholl D, Schadrack J. The burden of chronic low back pain with and without a neuropathic component: a healthcare resource use and cost analysis. J Med Econ. 2012;15:245–52.

    Article  Google Scholar 

  3. Hartvigsen J, Lings S, Leboeuf-Yde C, Bakketeig L. Psychosocial factors at work in relation to low back pain and consequences of low back pain; a systematic, critical review of prospective cohort studies. Occup Environ Med BMJ Publishing Group; 2004;61:e2.

  4. Wai EK, Roffey DM, Bishop P, Kwon BK, Dagenais S. Causal assessment of occupational lifting and low back pain: results of a systematic review. Spine J. 2010;10:554–66.

    Article  Google Scholar 

  5. Wai EK, Roffey DM, Bishop P, Kwon BK, Dagenais S. Causal assessment of occupational carrying and low back pain: results of a systematic review. Spine J. 2010;10:628–38.

    Article  Google Scholar 

  6. Wai EK, Roffey DM, Bishop P, Kwon BK, Dagenais S. Causal assessment of occupational bending or twisting and low back pain: results of a systematic review. Spine J. 2010;10:76–88.

    Article  Google Scholar 

  7. Juniper M, Le TK, Mladsi D. The epidemiology, economic burden, and pharmacological treatment of chronic low back pain in France, Germany, Italy, Spain and the UK: a literature-based review. Expert Opin Pharmacother. 2009;10:2581–92.

    Article  CAS  Google Scholar 

  8. de Looze MP, Bosch T, Krause F, Stadler KS, O’Sullivan LW. Exoskeletons for industrial application and their potential effects on physical work load. Ergonomics. 2016;59:671–81.

    Article  Google Scholar 

  9. Gopura RARC, Kiguchi K. Mechanical designs of active upper-limb exoskeleton robots: state-of-the-art and design difficulties. IEEE Int Conf Rehabil Robot IEEE; 2009, Kyoto, 2009. pp. 178–87.

  10. Godwin AA, Stevenson JM, Agnew MJ, Twiddy AL, Abdoli-Eramaki M, Lotz CA. Testing the efficacy of an ergonomic lifting aid at diminishing muscular fatigue in women over a prolonged period of lifting. Int J Ind Ergon. 2009;39:121–6.

    Article  Google Scholar 

  11. Lotz CA, Agnew MJ, Godwin AA, Stevenson JM. The effect of an on-body personal lift assist device (PLAD) on fatigue during a repetitive lifting task. J Electromyogr Kinesiol. 2009;19:331–40.

    Article  Google Scholar 

  12. Abdoli-Eramaki M, Stevenson JM, Reid SA, Bryant TJ. Mathematical and empirical proof of principle for an on-body personal lift augmentation device (PLAD). J Biomech. 2007;40:1694–700.

    Article  Google Scholar 

  13. Ulrey BL, Fathallah FA. Effect of a personal weight transfer device on muscle activities and joint flexions in the stooped posture. J Electromyogr Kinesiol. 2013;23:195–205.

    Article  Google Scholar 

  14. Graham RB, Agnew MJ, Stevenson JM. 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. Appl Ergon. 2009;40:936–42.

    Article  Google Scholar 

  15. Wehner M, Rempel D, Kazerooni H. Lower extremity exoskeleton reduces back forces in lifting. ASME 2009 Dyn Syst Control Conf Vol 2 ASME; Hollywood, 2009; pp. 49–56

  16. Hondzinski JM, Ikuma L, de Queiroz M, Wang C. Effects of exoskeleton use on movement kinematics during performance of common work tasks: a case study. Work. 2019;61:575–88.

    Article  Google Scholar 

  17. Baltrusch S., van Dieën JH, Bennekom CA., Houdijk H. Testing an exoskeleton that helps workers with lower-back pain: less discomfort with the passive SPEXOR trunk device. IEEE Robotics & Automation Magazine 2020; [ahead of print].

  18. Baltrusch SJ, van Dieën JH, Bruijn SM, Koopman AS, van Bennekom CAM, Houdijk H. The effect of a passive trunk exoskeleton on metabolic costs during lifting and walking. Ergonomics. 2019;62:903–16.

    Article  CAS  Google Scholar 

  19. Weston EB, Alizadeh M, Knapik GG, Wang X, Marras WS. Biomechanical evaluation of exoskeleton use on loading of the lumbar spine. Appl Ergon. 2018;68:101–8.

    Article  Google Scholar 

  20. Koopman AS, Kingma I, Faber GS, de Looze MP, van Dieën JH. Effects of a passive exoskeleton on the mechanical loading of the low back in static holding tasks. J Biomech. 2019;83:97–103.

    Article  Google Scholar 

  21. Bosch T, van Eck J, Knitel K, de Looze M. The effects of a passive exoskeleton on muscle activity, discomfort and endurance time in forward bending work. Appl Ergon. 2016;54:212–7.

    Article  Google Scholar 

  22. Baltrusch SJ, van Dieën JH, van Bennekom CAM, Houdijk H. The effect of a passive trunk exoskeleton on functional performance in healthy individuals. Appl Ergon. 2018;72:94–106.

    Article  CAS  Google Scholar 

  23. de Looze MP, Krause F, O’Sullivan LW. The potential and acceptance of exoskeletons in industry. In: González-Vargas J, Ibáñez J, Contreras-Vidal JL, van der Kooij H, Pons J, editors. Wearable robotics: challenges and trends. Cham: Springer; 2017. p. 195–195.

    Chapter  Google Scholar 

  24. Hill D, Holloway CS, Morgado Ramirez DZ, Smitham P, Pappas Y. What are user perspectives of exoskeleton technology? A literature review. Int J Technol Assess Health Care. 2017;33:160–7.

    Article  Google Scholar 

  25. Näf MB, Koopman AS, Baltrusch S, Rodriguez-Guerrero C, Vanderborght B, Lefeber D. Passive back support exoskeleton improves range of motion using flexible beams. Front Robot Al Front. 2018;5:72.

    Article  Google Scholar 

  26. Viteckova S, Kutilek P, Jirina M. Wearable lower limb robotics: a review. Biocybern Biomed Eng. 2013;33:96–105.

    Article  Google Scholar 

  27. Babič J, Mombaur K, Lefeber D, van Dieën J, Graimann B, Russold M, et al. SPEXOR: spinal exoskeletal robot for low back pain prevention and vocational reintegration. In: González-Vargas J, Ibáñez J, Contreras-Vidal J, van der Kooij H, Pons J, editors. Wearable robotics: challenges and trends. Cham: Springer; 2017. p. 311–315.

    Chapter  Google Scholar 

  28. Marras WS, Ferguson SA, Burr D, Davis KG, Gupta P. Spine loading in patients with low back pain during asymmetric lifting exertions. Spine J. 2004;4:64–75.

    Article  Google Scholar 

  29. Ferguson SA, Marras WS, Burr DL, Davis KG, Gupta P. Differences in motor recruitment and resulting kinematics between low back pain patients and asymptomatic participants during lifting exertions. Clin Biomech. 2004;19:992–9.

    Article  Google Scholar 

  30. Smith RL. Therapists’ ability to identify safe maximum lifting in low back pain patients during functional capacity evaluation. J Orthop Sports Phys Ther. 1994;19:277–81.

    Article  CAS  Google Scholar 

  31. Reneman MF, Kool J, Oesch P, Geertzen JHB, Battié MC, Gross DP. Material handling performance of patients with chronic low back pain during functional capacity evaluation: a comparison between three countries. Disabil Rehabil. 2006;28:1143–9.

    Article  CAS  Google Scholar 

  32. Gross DP, Battié MC. Reliability of safe maximum lifting determinations of a functional capacity evaluation. Phys Ther. 2002;82:364–71.

    Article  Google Scholar 

  33. Gross M, Dailey ES, Dalton MD, Lee AK, McKiernan TL, Vernon WL, et al. Relationship between lifting capacity and anthropometric measures. J Orthop Sports Phys Ther. 2000;30:237–47.

    Article  CAS  Google Scholar 

  34. Koopman A, Näf M, Baltrusch S, Kingma I, Rodriguez-Guerrero C, Babič J, et al. Biomechanical evaluation of the SPEXOR passive back support exoskeleton. J Biomech. 2020;Under review.

  35. Baltrusch SJ, van Dieën JH, Koopman AS, Näf MB, Rodriguez-Guerrero C, Babič J, et al. SPEXOR passive spinal exoskeleton decreases metabolic cost during symmetric repetitive lifting. Eur J Appl Physiol. 2020;120:401–12.

    Article  CAS  Google Scholar 

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Acknowledgements

The work presented in this paper was supported by the European Union’s Horizon 2020 research and innovation program under grant agreement No 687662—SPEXOR. Authors would like to thank all the partners in the SPEXOR consortium, especially the primary developers of the SPEXOR exoskeleton, prof. dr. ir. Dirk Lefeber, dr. ir. Carlos Rodriguez-Guerrero and ir. Matthias Näf.

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Authors and Affiliations

  1. Department of Health Study, Andrej Marusic Institute, University of Primorska, Koper, Slovenia

    Žiga Kozinc

  2. Department of Kinesiology and Physiotherapy, Faculty of Health Sciences, University of Primorska, Koper, Slovenia

    Žiga Kozinc & Nejc Šarabon

  3. Research and Development, Rehabilitation Centre Heliomare, Wijk aan Zee, The Netherlands

    Saskia Baltrusch & Han Houdijk

  4. Amsterdam Movement Sciences, Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands

    Saskia Baltrusch & Han Houdijk

  5. Laboratory for Motor Control and Motor Behaviour, S2P, Science To Practice, Ltd., Ljubljana, Slovenia

    Nejc Šarabon

  6. Faculty of Health Sciences, University of Primorska, Polje 42, 6310, Izola, Slovenia

    Nejc Šarabon

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  1. Žiga Kozinc
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  2. Saskia Baltrusch
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Correspondence to Nejc Šarabon.

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Kozinc, Ž., Baltrusch, S., Houdijk, H. et al. Short-Term Effects of a Passive Spinal Exoskeleton on Functional Performance, Discomfort and User Satisfaction in Patients with Low Back Pain. J Occup Rehabil 31, 142–152 (2021). https://doi.org/10.1007/s10926-020-09899-7

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  • DOI: https://doi.org/10.1007/s10926-020-09899-7

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