Abstract
Introduction: Musculoskeletal symptoms are a major occupational health concern worldwide, contributing to increased sickness absence, reduced work capacity, and substantial healthcare and economic costs. Wearable exoskeletons are increasingly used in industrial work to reduce musculoskeletal strain and support physically demanding tasks. The aim of this study was to review the user-exoskeleton interactions while performing industrial work tasks.
Methods: The relevant journal papers published between 2009 and 2024 from SciVerse Scopus and PubMed were extracted, following the PRISMA guidelines. The focus was on applications, evaluation methods, outcomes, and design challenges.
Results: One hundred and fifty-five papers included in the review. Fifty-two different industrial exoskeletons were identified (20 active and 32 passive exoskeletons), which were mainly evaluated in manual lifting/lowering (56%), overhead (29%), and assembly (6%) tasks. The exoskeletons were generally aimed to support the back (51%) and arms (21%). The exoskeletons decreased muscle activity levels (9–81%) and physiological strain (oxygen consumption and heart rate) as well as perceived exertion and discomfort experience, although they had negative consequences in terms of balance control and stability, working postures, and joint range of motion. The effects of exoskeletons on muscle fatigue, musculoskeletal/biomechanical loading and performance measures were contradictory. Most studies were short-duration lab trials, limiting generalizability to real workplaces. Key challenges include lack of standardized evaluation protocols, limited field validation, and potential for unintended biomechanical effects.
Conclusion: Findings support the need for harmonized testing methods, longer field trials, and user-centered designs to ensure safe and effective implementation in industrial settings.