Saskia Baltrusch

237 Chapter 9 Thus, Chapters 6 and 7 demonstrate that the design features that were identified in Chapters 2, 3 and 4 were successfully implemented in the SPEXOR exoskeleton which resulted in improved functional performance and aerobic loading when using the SPEXOR exoskeleton, with relatively low levels of discomfort and high levels of user satisfaction. These effects seemed superior to the benchmark, presented in Chapters 3 and 4. Part 3: How does the exoskeleton influence self-efficacy of potential end-users and how can acceptability of the device be improved? In the last part of my thesis, I focused on challenges for acceptance and implementation of the exoskeleton in the working environment. Specifically, in Chapter 8 , a mixed methods approach was used, performing quantitative measurements on self-efficacy, and conducting focus groups and interviews with employees suffering from low-back pain and managers from the same company. As self-efficacy is valuable for successful implementation of a device, I assessed the effect of the SPEXOR exoskeleton on self-efficacy using the Modified Spinal Function Sort (M-SFS). The findings demonstrated that the SPEXOR exoskeleton increases self-efficacy, especially for people feeling strongly restricted by their low-back pain. The focus groups and interviews confirmed and complemented these results, demonstrating the flexibility of the exoskeleton as an advantage to current static and inflexible external lifting devices and the perceived support during main tasks of employees. In line with Chapter 2 , the results further indicated that a suitable implementation strategy and adequate communication between end-user and decision makers is important for successful device implementation. What is the added value of a user-centered approach? A user-centered approach is well developed in the field of technology studies, in which innovation is seen as a process of ‘co-construction’ [1]. Researchers, designers and potential end-users actively work together when developing an innovation. However, in passive exoskeleton technology research, this approach is still scarce [2]. Given the benefits of end-user involvement found in medical device development, described in Chapter 1, I implemented a user-centered approach in this thesis. Figure 1 illustrates at which stages of the thesis potential 9