Saskia Baltrusch

38 Chapter 2 rather than supporting them in moving again. Patients perceived this “guarding” as more stability in the back and felt more confident. Translating the concerns on confirming inability and adapting movement behavior into design requirements, an exoskeleton should increase patients’ confidence rather than confirming inability. If users feel more confident in performing tasks when wearing the device, they may be more likely to return to work [36].This confidence cannot be achieved by only adapting the design of the device but rather depends on the implementation strategy of the device in the rehabilitation setting and on adequate communication between patient and healthcare professional. Another concern of healthcare professionals was the fact that low-back pain would mainly be a psychological problem, whereas the assistive device would focus on low-back pain as a biomechanical problem. Previous epidemiological research has shown that both, biomechanical and psychological risk factors are associated with low-back pain [1,2]. In contrast to our study, a cross sectional study by Stevens et al. (2016) [37], who investigated patients’ and physiotherapists’ views on triggers for low-back pain, showed that both groups endorse biomechanical risk factors as the most important risk factor category. Asking participants in a short survey to name triggers for a sudden episode of acute low-back pain, Stevens et al. (2016) [37] provides only a rough overview of responses. Due to the qualitative approach, our study adds more insight into the spectrum of personal experience in the context of developing an assistive device. This might explain the difference we found in the healthcare professionals’ beliefs compared to the study of Stevens et al. (2016) [37]. It should still be noted that the use of a spinal assistive device is more likely to show beneficial effects for patients with mechanical low-back pain, as this is the nature of the device. Important design characteristics that were directly mentioned during the discussions were comfort, adjustability to align the device to the individual user, and independency in taking it on and off. Furthermore, the possibility of gradual adjustment of support was considered as advantageous in order to provide task- specific support and versatility, hence being able to perform a variety of tasks without hindrance. Previous research has shown that comfort and versatility