Saskia Baltrusch

22 Chapter 2 Abstract Objective: The objective of this study was to identify criteria to be considered when developing an exoskeleton for low-back pain patients by exploring the perceptions and expectations of potential end-users. Background: Psychosocial, psychological, physical load and personality influence incidence of low-back pain. Body-worn assistive devices that passively support the user’s trunk, i.e. exoskeletons, can decrease mechanical loading and potentially reduce low-back pain. A user-centred approach improves patient safety and health outcomes, increases user satisfaction and ensures usability. Still, previous studies have not taken psychological factors and the early involvement of end- users into account. Methods: We conducted focus group studies with low-back patients (n=4) and healthcare professionals (n=8). Focus group sessions were audio-recorded, transcribed and analysed, using the General Inductive Approach. The focus group discussions included trying out a currently available exoskeleton. Questions were designed to elicit opinions about exoskeletons, desired design specifications and usability. Results : Important design characteristics were comfort, individual adjustability, independency in taking it on and off and gradual adjustment of support. Patients raised concerns over loss of muscle strength. Healthcare professionals mentioned the risk of confirming disability of the user and increasing guarded movement in patients. Conclusion : The focus groups showed that implementation of a trunk exoskeleton to reduce low-back pain requires an adequate implementation strategy, including supervision and behavioral coaching. Application: For healthcare professionals the optimal field of application, prevention or rehabilitation, is still under debate. Patients see potential in an exoskeleton to overcome their limitations and expect it to improve their quality of life.