Saskia Baltrusch

12 Chapter 1 Although we are committed to scientific truth, there comes a point where this truth is not enough, where the application of truth to human objectives comes into play. Once we start to think in terms of utility, we must leave the placid environment of the laboratory, take off our white coats, and roll up our sleeves. (Samuel Florman—“The Civilized Engineer”) End-user involvement can contribute to the acceptance and success of products [21]. In medical device development, a user-centred design is a common approach and widely recommended, since it improves user acceptance, satisfaction and patient safety [22]. However, within the area of exoskeleton development such a user-centred approach is still rare. A literature review by Hill et al. (2017) [23] aimed to identify existing literature on user-involvement in designing wearable assistive materials. To date, there have been no published studies that consider the user’s perspective of exoskeleton technology when developing an exoskeleton for the trunk. Previous studies on assistive technology for neurological disabilities also stress the importance of taking into consideration the user perspective [24, 25]. Hill et al. (2017) [23] conclude that future research that focuses on aspirations and concerns of potential exoskeleton users is needed to fulfil the potential of exoskeleton technology. By understanding difficulties faced by end- users, researchers can improve the design of exoskeleton technology. This is why the SPEXOR project incorporated a user-centred approach. Target population As discussed above, an exoskeleton has the potential to be used in both rehabilitation and industry. In this thesis, I therefore included two populations: low-back pain patients who undergo rehabilitation and employees being at risk of getting low-back pain or who are suffering from (a history of) low-back pain but are still able to work. Both groups are potential end-users of a passive exoskeleton and, as described above, have to be considered and listened to when developing a new exoskeleton. Through their involvement at different stages within the project, I aimed to receive personal feedback and opinions regarding their wishes and doubts with respect to an exoskeleton, but also on the design itself to improve usability and acceptability of the device. Given the iterative design process of the SPEXOR project, I also included participants who