Exoskeleton at workplace: myth or fact? A randomized controlled trial for a mid-long term applicability in the real industry setting. - Finanziato dall’Unione europea – Next Generation EU

Work-related musculoskeletal disorders (WRMSDs) can be defined as abnormalities in soft tissues of upper limbs and lower limbs, bones, and joints, such as the spine (1). WRMSDs are one of the main problems in occupational health, resulting in high costs, decreased productivity and poorer health-related quality of life (2). Preventive actions are therefore necessary to lower WRMSDs incidence and to lessen pain symptoms. The most frequently implemented actions to counteract the onset and symptomatology of WRMSDs are worker training and ergonomic interventions to counteract the risk of biomechanical overload. Among those actions, the use of exoskeleton is strongly increasing, but not widely used. There are many reasons for this, first and foremost the lack of knowledge and acceptance. However, from a musculoskeletal point of view, there is a lack of knowledge about the long-term benefits in its use (3). Another relevant aspect regards the biomechanical overload risk calculation. This estimation is compulsory under Italian law (D.LGS. 9 aprile 2008, n. 81, title VI, annex XXXIII). Risk is calculated using the ISO-11228 technical standards (parts 1, 2, and 3) refer to manual handling and flat transport (4), pushing-pulling (5) and high frequency handling of light loads (6), respectively. These risk indicators do not include the adoption of an exoskeleton, or a linkable variable, in the risk calculation. Practically, there are no components that influence the current risk prediction equations for biomechanical overload. Once industry has been recruited to participate in the project, the type of exoskeleton available on the market will be identified. The criterion for the selecting of the exoskeleton will be based on the quantity and quality of available scientific evidence. The project develops then in 2 operative phases. The first one is an observational phase in which the selected workstations will be evaluated. The assessments will focus on ergonomics, while the workers and their workstations will be assessed by electromyography, energy expenditure (related to the work activity), symptoms related to WRMSDs, pain and physical efficiency. The second phase of the research project will be defined as interventional phase in which the workers involved will wear the exoskeleton. The same operators will be evaluated at the beginning and at the end of the period of exoskeleton use, with the same measurements as in the observational phase. In addition, other assessments (exoskeleton acceptability and perceived comfort / discomfort and impact on quality of life) will also be tested. The main objective is to evaluate the long-term response to the use of exoskeleton within work environment for the parameters mentioned above and the impact of exoskeleton in the equations for predicting the risk of biomechanical overload.