Saskia Baltrusch

241 Chapter 9 The request by the focus group participants for a versatile exoskeleton, as mentioned in the previous paragraph, also influenced the test battery that I developed to evaluate the SPEXOR exoskeleton. Besides tasks that assess the support of the exoskeleton, I also included tasks in my test battery that assess whether the exoskeleton does not hinder the user in work-related tasks and range of motion tasks, as described in Chapter 3. In this way, it was possible to not only investigate the supportive but also the versatile character of the device. In addition, to be able to get iterative feedback from potential-end users on the design and the perceived functioning of the SPEXOR exoskeleton, functional performance was assessed in terms of objective and subjective outcome measures. In addition, I added the Users’ Impression Questionnaire to identify acceptability of the device to the user. The importance of an adequate implementation strategy An important outcome of the user-centered approach, as described in Chapters 2 and 8, is the proclaimed importance of an adequate implementation strategy when aiming for introducing an exoskeleton in a new environment. As stated in Chapter 2, confidence in the own capabilities with regard to low-back pain cannot solely be achieved by adapting the design of the exoskeleton, but also depends on adequate communication between healthcare professional and patient. Previous studies have shown that good communication skills in a doctor improve patient’s compliance and overall satisfaction [4-6]. Also, perspectives of healthcare professionals can be different to patients’ perspectives, and healthcare professionals should be aware that their beliefs and attitudes influence their patients’ beliefs and attitudes [7]. The effect of the exoskeleton on the confidence of low-back pain patients is therefore dependent on how healthcare professionals communicate about using an exoskeleton towards patients. Healthcare professionals should provide guidance and coaching when using the exoskeleton, talking about issues such as: How long and how often should the patient wear the exoskeleton? In which situations does the patient need support? Focusing on the advantages of a passive exoskeleton, rather than confirming the patients’ concerns, will influence the patient’s belief in how the exoskeleton will influence their behavior and their low-back pain. “It’s important to make sure that we’re talking with each other in a way that heals, not in a way that wounds.” (Barack Obama) 9