Evaluating Exoskeletons for WMSD Prevention: A Systematic Review of Applications and Ergonomic Approach in Occupational Settings

Abstract

This review provides a comprehensive analysis of studies investigating the impact of occupational exoskeletons on work-related musculoskeletal disorder (WMSD) risk factors. The primary objective is to examine the methodologies used to assess the effectiveness of these devices across various occupational tasks. A systematic review was conducted following the PRISMA guidelines, covering studies published between 2014 and 2024. A total of 49 studies were included, identified through searches conducted in Scopus and Web of Science databases, with the search string launched in August 2024. The review identifies a growing body of research on passive and active exoskeletons, with a notable focus on laboratory-based evaluations. The results indicate that direct measurement and self-report methods are the preferred approaches in these domains. Ergonomic limitations and user discomfort remain concerns in some cases. The findings of this review may influence stakeholders by providing insights into the potential benefits of adopting exoskeletons and improving workplace ergonomics to reduce WMSD risks. Additionally, the identification of WMSD assessment methods will be valuable for validating the use of these technologies in the workplace. The review concludes with recommendations for future research, emphasizing the need for more real-world assessments and improved exoskeleton designs to enhance user comfort and efficacy.

Keywords: WMSD; ergonomics; exoskeleton; occupational settings; risk assessment methods.

Figure 1

Steps of the PRISMA protocol for the literature review on WMSD risk assessment methods in assistive working (adapted from Moher et al. (2009) [39]).

Figure 2

Distribution of the biomechanical direct measurement approaches by the number of studies.

Figure 3

Distribution of the physiological direct measurement approaches by the number of studies.

Figure 4

Distribution of the muscles studied by the number of studies. Anterior deltoid (AD); anterior serratus (AS); biceps brachii (BB); biceps femoris (BF); brachioradialis (BR); external obliquus abdominis (EOA); erector spinae (ES); erector spinae iliocostalis (ESI); erector spinae longissimus lumborum (ESLL); erector spinae longissimus thoracis (ESLT); flexor digitorum profundus (FDP); gluteus maximus (GM); gluteus medius (GMD); gastrocnemius medialis (GTM); internal obliquus abdominis (IOA); latissimus dorsi (LD); lower trapezius (LT); middle deltoid (MD); multifidus (MF); middle trapezius (MT); posterior deltoid (PD); pectoralis major (PM); quadriceps femoris (QF); quadratus lumborum (QL); rectus abdominis (RA); rectus femoris (RF); splenius capitis (SC); sternocleidomastoid (SCM); semitendinosus (STD); tibialis anterior (TA); tensor fascia latae (TFL); triceps brachii (TB); upper trapezius (UT); vastus lateralis (VL).

Figure 5

Distribution of the self-report/checklist methods by number of studies.

Figure 6

Distribution of the reviewed studies on ergonomic benefits.