Saskia Baltrusch

234 Chapter 9 General Discussion The overarching aim of this thesis was to study the potential effectiveness of using a passive trunk exoskeleton (SPEXOR) for low-back pain prevention and vocational reintegration and to provide insight into factors that can influence the usability and acceptability of such an exoskeleton. To take into consideration the end-user’s perspective and to ensure a comprehensive assessment, I used a user-centered approach and combined qualitative and quantitative research methods. In this discussion, I will first give a summary of the results, interrelating the findings of the different chapters. Subsequently, I will interpret these findings in the light of the user-centered approach used in this thesis. Finally, I will discuss implications for future research, clinical practice and the occupational field. Summary Given the rising prevalence of low-back pain and the challenge of reducing occupational risk factors at work, a passive trunk exoskeleton that decreases the mechanical loading on the back might be a promising approach to overcome limitations of previous interventions. This thesis comprised three main parts. Part 1: Which factors should be considered, from the end-users’ perspective, when designing an exoskeleton for people with low-back pain? This first part was covered in Chapter 2, in which I reported a focus group study with low-back pain patients and healthcare professionals to explore perceptions and expectations of potential end-users. Wishes and doubts towards the use of a passive trunk exoskeleton for low-back pain patients, design requirements and limitations of current devices were discussed. The results suggest that a trunk exoskeleton should provide gradual adjustment of support and should be versatile to support different movements beyond bending and lifting. Additionally, it should only be used temporarily and with guidance of a health care professional to prevent loss of muscle strength. Other important design requirements were comfort and independency in taking it on and off. Health care professionals considered exoskeletons useful as preventive measures at the work site. They believed, when used by low-back pain patients in rehabilitation, it can decrease the patient’s confidence by confirming disability and increasing