The evaluation of the effectiveness of industrial back-support exoskeleton (BSEs) in caregiving activities

<p dir="ltr">The overarching aim of this PhD research was to explore the potential for implementing back-support exoskeletons (BSEs) in healthcare settings, with a particular focus on care homes. Although exoskeletons have been widely adopted and proven effective in industrial sectors such as manufacturing, automotive, and logistics, limited research has been conducted on their application in healthcare, especially in supporting physically demanding caregiving tasks. This research addressed this gap by investigating the types of BSEs suitable for caregiving, identifying caregiving tasks that may benefit from such support, and evaluating the effectiveness of BSEs in reducing the physical and physiological workload of carers. The research was structured around four interrelated studies.</p><p dir="ltr">First, a systematic literature review examined the effectiveness of BSEs in tasks involving repetitive lifting, static trunk bending, and dynamic trunk bending. These tasks are common components of caregiving activities. Findings highlighted reductions in muscle activity, physiological demand, and improved posture underscoring the potential benefits of BSEs in caregiving activities.</p><p dir="ltr">The second study involved a survey of carers (n = 60) from care homes across the UK, capturing demographic data, work characteristics, physical workloads, musculoskeletal complaints, and perceptions of BSE use. The results identified bathing, transferring, and repositioning care recipients as the most physically demanding tasks. These findings informed the selection of caregiving simulations for subsequent experimental studies.</p><p dir="ltr">The third study addressed the methodological challenge of collecting VO2 by breathing through a face mask during simulated caregiving tasks. It validated VO2 estimation from heart rate data using three incremental exercise tests. Standing arm crank test was found that it produced the most accurate VO2 compared to VO2 data collected during caregiving simulation.</p><p dir="ltr">The final experimental study evaluated the effects of two commercial BSE models (SuitX AC and SuitX S) on physical and physiological workload during simulated caregiving tasks (bathing, repositioning, and hoisting). Twenty healthy participants were recruited. The results demonstrated that both BSE models significantly reduced back muscle activity and time spent in excessive trunk flexion, without significantly increasing physiological workload. These findings suggest that BSEs have the potential to serve as effective ergonomic interventions in caregiving.</p><p dir="ltr">The thesis concludes by discussing the practical implications, limitations, and future opportunities for implementing BSEs in care home environments. It also outlines design considerations for developing BSEs tailored to the unique needs of the caregiving workforce and care home settings.</p>