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A Systematic Review on Lower-Limb Industrial Exoskeletons: Evaluation Methods, Evidence, and Future Directions

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Abstract

Industrial tasks that involve frequent sitting/standing transitions and squatting activities can benefit from lower-limb industrial exoskeletons; however, their use is not as widespread as their upper-body counterparts. In this review, we examined 23 articles that evaluated the effects of using Wearable Chair (WC) and Squat-assist (SA) exoskeletons. Evaluations mainly included assessment of muscular demands in the thigh, shank, and upper/lower back regions. Both types of devices were found to lessen muscular demands in the lower body by 30–90%. WCs also reduced low-back demands (~ 37%) and plantar pressure (54–80%) but caused discomfort/unsafe feeling in participants. To generalize outcomes, we suggest standardizing approaches used for evaluating the devices. Along with addressing low adoption through design upgrades (e.g., ground and body supports/attachments), we recommend that researchers thoroughly evaluate temporal effects on muscle fatigue, metabolic rate, and stability of wearers. Although lower-limb exoskeletons were found to be beneficial, discrepancies in experimental protocols (posture/task/measures) were discovered. We also suggest simulating more realistic conditions, such as walking/sitting interchangeability for WCs and lifting loads for SA devices. The presented outcomes could help improve the design/evaluation approaches, and implementation of lower limb wearable devices across industries.

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Authors and Affiliations

  1. Biomechanics and Ergonomics Lab, Industrial and Systems Engineering Department, Rochester Institute of Technology, 1 Lomb Memorial Dr, Rochester, NY, 14623, USA

    Pranav Madhav Kuber & Ehsan Rashedi

  2. Department of Orthopaedic Surgery, Harvard Medical School, Boston, MA, USA

    Mohammad Mehdi Alemi

  3. Training Services, MathWorks, Natick, MA, USA

    Mohammad Mehdi Alemi

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Appendix 1

Appendix 1

See Table 5.

Table 5 A summary of risk of bias for the included articles including B1: Bias arising from randomization process, B2: Bias due to deviations from intended interventions, B3: Bias due to missing outcome data, B4: Bias in measurement of the outcome, B5: Bias in selection of the reported result. The articles have been assessed with the following conventions: Low risk of bias ( +), Unclear risk of bias (?), High risk of bias ( −) (Adapted from 54)
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Kuber, P.M., Alemi, M.M. & Rashedi, E. A Systematic Review on Lower-Limb Industrial Exoskeletons: Evaluation Methods, Evidence, and Future Directions. Ann Biomed Eng 51, 1665–1682 (2023). https://doi.org/10.1007/s10439-023-03242-w

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