Considerations for Industrial Use: A Systematic Review of the Impact of Active and Passive Upper Limb Exoskeletons on Physical Exposures

Background: Recently, interest has surged regarding industrial-use exoskeletons as personal protective equipment to reduce work-related musculoskeletal disorders (MSDs). Purpose: Reviews existing evidence on the efficacy and effectiveness of industrial-use upper limb exoskeletons for reducing exposures to factors linked to MSD risk, and for improving productivity and quality. Methods: Scopus, PubMed, and CINAHL were searched systematically for relevant, English, peer-reviewed journal articles published between January 2000 and February 2019. Retained papers were quality-appraised using a modified CONSORT 2010 checklist, where an evidence synthesis algorithm was used to determine the level of evidence separately for active and passive exoskeletons. Results: A total of 799 articles were retrieved, 14 articles of which met inclusion criteria and were retained for analysis. Studies commonly reported on the effects of exoskeleton use on measures of muscular activity; endurance and fatigue; kinematics and range of motion; productivity and quality; discomfort and pain; and usability and subjective feedback. A moderate level of evidence was found supporting the efficacy of passive upper limb exoskeletons in reducing muscular demand on the anterior and middle deltoid muscles during occupational tasks, particularly overhead work; however, there is limited and insufficient evidence regarding impacts on measures related to kinematics and fatigue. There is insufficient evidence to support the use of active exoskeletons, due to the lack of medium-to-high quality studies with consistent findings. Conclusions: Considering the current state of evidence, those considering upper-limb exoskeletons for MSD prevention, particular for overhead work, may wish to consider passive systems rather than active systems at this time. High-quality research should continue to investigate the efficacy of active systems and effectiveness of both active and passive exoskeletons as an intervention to reduce MSDs. Exoskeleton efficacy and effectiveness research quality can be improved by including samples representative of industrial workers and by strengthening study power.