Saskia Baltrusch

224 Chapter 8 Quantitative data demonstrated that the majority of the participants showed a high self-efficacy base score, with limited increase in self-efficacy after trying out the exoskeleton. This indicates that they do not feel highly restricted by their low-back pain and thus do not see the need to wear an exoskeleton. Luggage handlers confirmed that outcome, as they did not consider a preventive use of an exoskeleton as needed, but would only wear the exoskeleton when suffering from low-back pain. In contrast, managers stressed the importance of using an exoskeleton as prevention, to protect employees from low-back pain in the long- term. To deal with potential refusal of using the exoskeleton as prevention, they suggested contractual obligation, which might facilitate the managers’ control over using the exoskeleton at work. On the other hand, with an increased self- efficacy when wearing the exoskeleton, as found in the quantitative assessment, acceptability is likely to increase and contractual obligation might be unnecessary. Certainly, these findings demonstrate that the implementation strategy is of importance to convince and support employees to use a spinal exoskeleton at work. The importance of an adequate implementation strategy was also highlighted in a previous study [34], in which design requirements for an exoskeleton used in rehabilitation were discussed with health care professionals and low-back pain patients. Supervision and behavioural coaching were considered as important strategies to ensure the correct use of the exoskeleton. Given the different field of application in the present study, implementation strategies should be more focused on increasing acceptability of the device to guarantee that employees actually use the exoskeleton. To improve acceptability and usability of an exoskeleton, design requirements from potential end-users should be considered to meet their specific needs [35]. Participants of the focus group and the interview mentioned some design specifications. Given the time constraints and their shift work, the exoskeleton should be easily and quickly adaptable to different body sizes. This might also decrease time pressure and stress, which is a psychological risk factor for an onset of LBP [36]. Additionally, a comfortable and wear-resistant exoskeleton increases its versatility to be implemented at different work locations and for different working tasks. This is in line with previous research that has shown that versatility and comfort are important for user acceptance [9,30].